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Dental Caries

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  • In classification of dental caries, what class is the caries located on the middle third of anterior teeth?
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  • 1. DENTAL CARIES
    Dr.Toutouni
  • 2. OVERVIEW
    DEMOGRAPHIC “RISK FACTORS”
    BIOLOGIC& ENVIROMENTAL “RISK FACTORS “& “RISK INDICATORS”
    ROOT CARIES
    EARLY CHILDHOOD CARIES
    DESCRIPTION & HISTORY
    MEASUREMENT
    DIAGNOSING CRITERIA
    “CARIES FREE”
    DISTRIBUTION
    SECULAR VARIATIONS IN CARIES EXPRIENCE
    Dr.Toutouni
  • 3. Description
    Dental caries is a mutifactorial disease that dissolve and destroy mineralized dental tissues.
    Dr.Toutouni
    MICROORGANISMS
    SUBSTRATE
    TIME
    HOST & TEETH
  • 4. History ( Measurement):
    From early Twentieth century:
    1- Proportion of lost molars through caries
    2-The percentage of erupted permanent teeth affected by caries
    Problem: Lack of sensitivity
    Bodeckers’ index: decayed surfaces
    Problem: Complicated
    Forerunner of DMF index: Dean
    Dr.Toutouni
  • 5. INDICES
    DISEASE
    DMF INDEX
    dmf
    def
    df
    SiC INDEX
    GRAINGER’S HIERARCHY
    HEALTH
    “CAREIS FREE” PERCENTAGE
    FS-T INDEX
    T-HEALTH INDEX
    Dr.Toutouni
  • 6. DMF INDEX:
    Applied only to permanent teeth
    D Decayed,
    M Missing due to caries,
    F Filled
    DMF score for a group: The sum of individual values
    The number of subjects examined
    Can have a Decimal value (continuous numerical scale)
    For all teeth: DMFT, For surfaces: DMFS
    Modifications: Recurrent caries, Crowned teeth, Bridge pontics , Sealed teeth DMFST, DMFSS
    In large a survey: Half –mouth
    Dr.Toutouni
  • 7. Limitations:
    No” at risk” teeth
    No denominator
    No declaration of intensity of attack
    Should be stated with age
    equal weight to D,M, F
    Little estimation of treatment needs
    Should be stated with “caries free” percent
    Recall bias
    Overestimation
    Compress extreme values
    Dr.Toutouni
  • 8. SiC INDEX:
    Significant caries index
    Description: The mean of the extremevalues of DMF index( In one- third of the population)
    Dr.Toutouni
  • 9. Dr.Toutouni
  • 10. Dr.Toutouni
  • 11. Dr.Toutouni
  • 12. Dr.Toutouni
  • 13. Health indices:
    FS_T index
    The sums of the sound and healthy restored teeth
    T-Health index
    Measure the amount of healthy dental tissue
    Assigns descending numerical weight for a sound tooth, Filled tooth, Decayed tooth
    Dr.Toutouni
  • 14. Dr.Toutouni
  • 15. Criteria for diagnosing caries:
    0.Surface sound: No treated or untreated caries( slight staining)
    D1.Initial caries: No clinically detectable loss of substance( sig staining in pit and fissures, discoloration, rough spots in enamel)
    D2. Enamel caries: Demonstrable loss of tooth substance in pits, fissures, smooth surfaces , no softened floor and wall or undermined enamel.
    D3. Caries of Dentin:Detectably softened floor, undermined enamel, softened wall or temporary filling
    D4.Pulpal involvement: Deep cavity with probable pulpal involvement, pulp should not be probed.
    Dr.Toutouni
  • 16. CASE ONE:
    Dr.Toutouni
  • 17. CASE TWO:
    Dr.Toutouni
  • 18. CASE THREE:
    Dr.Toutouni
  • 19. Dr.Toutouni
    CASE FOUR:
  • 20. CASE FIVE:
    Dr.Toutouni
  • 21. CASE SIX:
    Dr.Toutouni
  • 22. Dr.Toutouni
  • 23. Dr.Toutouni
  • 24. Criteria
    Pits and fissures are caries when:
    Opacity to the adjacent area providing evidence of undermining or demineralization.
    Softened enamel adjacent to the area that may be scraped by the explorer
    Visual method vs Visual- Tactile method
    A good proportion of noncavitated lesions remain static or even remineralize especially smooth surface lesions.
    Dr.Toutouni
  • 25. caries New methods in diagnosing
    Fiberoptictransillumination
    Electrical conductance
    Laser fluorescence
    Advantages:
    Do not change the approach to measuring caries
    Detect non-cavitatedlesions at an early stages
    Dr.Toutouni
  • 26. Hidden caries
    Dentinal caries found radiographically beneath apparently sound occlusal surface
    Rare condition:
    7.5% in Dutch and 2.5% in Lithuanian
    By- product of fluoride age
    Dr.Toutouni
  • 27. Caries free
    Free of caries requiring restorative treatment
    Activities like early demineralization- remineralization cycles, white spots, stained fissure does not progress
    “ without obvious lesion”
    Dr.Toutouni
  • 28. History ( Disease):
    Fifth to Seven centuries: Moderate caries experience
    More attrition, cervical & root caries
    Uncommon coronal caries
    Sixteenth century: Modern pattern ( Fissured & Proximal surfaces), in High-income nations
    Eighteenth century: Dietary changes
    The expansion : 1845-1875
    The end of nineteenth century: Endemic disease
    Dr.Toutouni
  • 29. DISTRIBUTION
    Most obvious reason : Diet
    For most of the 20th century:
    Disease of the High- income countries
    Low prevalence in poorer countries
    By the late 20th century:
    Sharply rising caries in low-income countries after world war II (1939-1945)
    Significant caries reduction in high-income countries
    Most data : DMFT
    Dr.Toutouni
  • 30. Dr.Toutouni
  • 31. Dr.Toutouni
  • 32. SECULAR VARIATTIONS IN CARIES EXPERIENCE:
    More affected teeth were attacked within 2-4 years after eruption
    Early 1980s: The greatest reduction in caries prevalence
    As caries prevalence falls:
    The least susceptible sites(proximal & smooth surfaces) The greatest proportion
    The most susceptible sites( occlusal) The smallest proportion
    Dr.Toutouni
  • 33. POLARIZATION
    Most caries occurs in relatively small number of children of the same age
    60% of all affected teeth are found in about 20% of children
    Three- Fourth of all affected teeth are found in One- Fourth of the children
    Dr.Toutouni
  • 34. DEMOGRAPHIC RISK FACTORS:
    Age
    In future: DMFT in all ages, M in adults, M & F in younger
    Dr.Toutouni
  • 35. DEMOGRAPGIC RISK FACTORS:
    Gender: Higher DMFT score in women
    Reasons: Earlier eruption of teeth
    Treatment factor
    Race & Ethnicity:white race has higher F, lower D & M
    Higher DMFT in minorities
    Dr.Toutouni
    In the same age, D&M are equal in men & women, but higher F in women
  • 36. :DEMOGRAPHIC RISK FACTORS
    Socioeconomic status:
    Social class is classified by: years of education, annual income, occupation, place of residence
    Reversely related to incidence of diseases
    In minorities: Higher SES Higher DMFT
    Familial & Genetic patterns : No transmission by Genetics
    Husband- wife similarities
    Mother to infant (window of infectivity)
    Just Form & Shape of the teeth
    Dr.Toutouni
  • 37. BIOLOGICAL RISK FACTORS & RISK :INDICATOR
    Bacterial infection:
    No bacteria, No caries
    Caries: ecologic imbalance
    Diet
    Nutrition
    Dr.Toutouni
  • 38. ROOT CARIES:
    Root caries is defined as caries that begins on cemental root surfaces below the cervical margin.
    Is found only where loss of periodontal attachment is present.
    Dr.Toutouni
  • 39. ROOT CARIES:
    Importance in community dentistry: AGING
    Geriatrics is a new field in community dentistry
    Dr.Toutouni
  • 40. RISK FACTORS :
    Loss of periodontal attachment
    Socioeconomic status
    Number of remaining teeth
    Use of dental services
    Oral hygiene levels
    Preventive behavior
    Multiple medication
    Radiotherapy
    Wearing partial denture
    Sucking candies in a dry mouth
    Living in an institution
    Higher coronal caries
    Gingival recession
    Low-Fluoride areas
    Smoking
    Race
    Xerostomia
    Dr.Toutouni
  • 41. ROOT CARIES:
    Root Caries Index:
    (Root surfaces: decayed + filled)* 100
    (Root surfaces with loss of periodontal
    attachment: decayed + filled + sound)
    Problems : It does not take into account thetime
    ,Sub gingival lesions.
    Dr.Toutouni
  • 42. EARLY CHILDHOOD CARIES:
    Presence of any decayed surface in children under 72 months.
    Most involved teeth: primary incisors & molars
    It is more prevalent in: Minorities( 70%), Deprived & Low SES ,LBW children, Chroniccariogenic diet.
    Importance in Community dentistry: Difficult & Costly treatment
    Dr.Toutouni
  • 43. EARLY CHILDHOOD CARIES:
    Labial caries, Baby Bottle Tooth Decay, Nursing caries,
    13%- 36% in IRAN ( under 6 years old, in 1386)
    Like Australia, Belgium, Hispanic
    Dr.Toutouni
  • 44. Dr.Toutouni
  • 45. Dr.Toutouni
    THANK YOU ANY QUESTION?