Dental Caries


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Community Dentistry
Third Year

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  • National preventive dentistry demonstration program NPDDP
  • *The high income grps have more access to the modern diet
  • Nations w better public health prevention have more success in caries prevention.
    Problem with DFM index is that measure the disease as much as the disease.
  • F effect.
    Although there is a great reduction in the new caries, more proportion are made up of pits and fissure lesions.
  • Comulative frequency curves showed that 60 % of all afected teeth are found in about 20 % of children: target the preventive programs into that minority.
  • Dental Caries

    1. 1. Dental caries PDS 372
    2. 2. Lecture outline • • • • • • • Global distribution of dental caries Secular variations in caries experience Uneven distribution of caries Demographic factors Risk factors and risk indicators Root caries Early childhood caries
    3. 3. Introduction • Dental caries is an ancient disease • Attrition surpassed caries formation • The modern pattern of caries in the highincome nations (16th century): – lesion began on fissured surfaces, later develop on proximal surfaces. • Dietary changes and dental caries – UK - import of sugar and dental caries increase
    4. 4. Global distribution of dental caries • Historic pattern change with adopting new cariogenic diets and lifestyles of the developed world • In the 20th century, Disease of the high-income countries…. Why? Diet* • By the later 20th century – Caries experience in low income-countries had risen post WWII – Marked reduction in caries experience among children and young adults in high-income countries
    5. 5. WHO and the global oral health data bank Country Initial DMFT China Cuba Morocco Saudi Arabia Thailand 0.8 2.9 2.3 2.0 1.5 Initial year 1983 1989 1991 1985 1984 Latest DMFT 1.0 1.4 2.5 1.7 1.6 Latest year 1996 1998 1999 1995 2001
    6. 6. Secular variations in caries experience • Caries prevalent, teeth are affected within 2-4 years of eruption • Reduction in caries with children of highincome nations • Problems exist with disparities • Greater reduction of incidence in smooth surfaces and proximal surfaces vs. occlusal*
    7. 7. • Pit and fissure lesions and the use of sealants • Caries decline…reasons? – Fluorides – Better oral hygiene – Changes in bacterial ecology – Pediatric antibiotics
    8. 8. • In high-income nations, reduction of caries led to the generations of “caries-free” children • Yet, there are the underprivileged who need to be addressed – DMFS of 7 or higher: severe disease • Free of caries requiring restorative treatment
    9. 9. • Age Demographic factors – Dental caries increase ? • DFM increase with age: more F in children and more M in adults – missing teeth – Childhood disease ?was – Lifetime disease? • yes, especially in communities with lower attack rate. • Gender – Female more ?y n studies, not reality – *Early eruption – *More restored teeth (treatment factor) – More dental visits – Men have more untreated teeth
    10. 10. Demographic factors • Race and ethnicity – Inherent is not a reason – Environmental is – Migration is: to area w diff diet – Socioeconomic differences are far more important • • • • • • Education Self-care practices Attitudes Values Income access to health care
    11. 11. Demographic factors • Socioeconomic Status (SES) – Social class (UK) – Is a broad recording of an individual’s attitudes and values as measured by factors such as • • • • Education Income Occupation Place of residence
    12. 12. Demographic factors • Socioeconomic Status (SES) – is inversely related to disease – Aspect of treatment differ bet. SES classes – Dental caries is a disease of poverty? Y now – Consider SES when planning public health programs – Fluoridation reduce the diff bet classes, but not remove it.
    13. 13. Demographic factors • Familial and genetic patterns – Familial tendencies • Bad teeth run in families • Does it: genetic basis, bacterial transmission, familial dietary, behavioral traits. – mother to infant bacteria transmission – Identical twins study: env. factors are stronger – Salivary flow and composition, tooth morphology and arch width are genetically determined
    14. 14. Risk factors and risk indicators • • • • • • Bacteria Diet Plaque deposits Saliva quantity and quality Enamel quality Tooth morphology
    15. 15. Risk factors and risk indicators • Bacterial infection – Necessary for caries formation – Most common flora: Strep mutans, Lactobacilli. – Ecologic imbalance rather than exogenous infection – Carbohydrate-modified bacterial infectious disease – High +ve count is a poor predictor of future caries
    16. 16. Risk factors and risk indicators • Nutrition and caries – Diet • Total oral intake of substance that provide energy and nourishment. – Nutrition • Absorption of nutrients. • Vitamin D deficiency: hypoplasia and caries • Severe malnutrition during the first year of life: delay eruption, exfoliation, reduce saliva flow. • Exposure to western diet
    17. 17. Risk factors and risk indicators • Diet and caries: clear influence – Refined carbs: Sugars – Sugar-starch mixtures (more cario than sugar alone) – Primitive races and caries experience: eating hard fibrous unprocessed food: better jaw and teeth development. – Miller (19th century) • Chemoparasitic theory (based on action of MO on fermentable carb that adhere to tooth suraface) – Protective food
    18. 18. Risk factors and risk indicators • Diet and caries – Epidemiologic studies • WWII studies: Japan, Norway, UK – delayed eruption after rationing. Less caries. • Hopewood house: – children on vege diet: 53% have no detectable caries compared with others 0.4% • Hereditary Fructose Intolerance: – they have no caries • Vipeholm study: – grps w ctrled comsumption of refined sugar vary in: amount, freq, phys form, time of consumption. Sticky sugar between the meals increase the caries. • Caries and soft drinks: – sugar in liquid form is cariogenic
    19. 19. Root caries • • • • • • • Location (cementum if recession) Polymicrobial Sugar are part of the etiology Prevalent in elderly in hi income Men are more affected Linked to periodontal attachment With increase tooth retention, susceptible root surfaces are increased • Less in hi fluoride ares. • More in smokers
    20. 20. Early childhood caries • Definition (any before 6 yo) – Severe caries in maxillary incisors • Incidence rates – In lower SES: lower education – At greater risk of permanent caries • Research: not linked with bottled milk – Prolonged exposure to liquid with sugars. • Prevention: education