Epidemiology of dental caries


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Epidemiology of dental caries

  2. 2. Host 1-Age. 2-Gender. 3-Race. 4-Genetic &familial. 5-Local host factors. Agent 1-Streptococcus mutans. 2-Lactobacilli. 3-Other microorganism. Environmental 1-Flouride. 2-Trace. 3-Water hardness. 4-Nutrition&diet. 5-Social factors. 6-Local oral environmen. 7-Climatological factors.
  3. 3. Multifactorial inter-action in the etiology of dental caries. Food com ponents Bacterial plaque Local host factors ) teeth & saliva (
  4. 4. GLOBAL DISTRIBUTION :-GLOBAL DISTRIBUTION :- During most of the 20th century High prevalence  developed countries 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.
  5. 5. BY THE 20BY THE 20thth CENTURY,CENTURY, PATTERN WAS CHANGEDPATTERN WAS CHANGED Prevalence and intensity were increased in many developing countries, at least in urban areas  Health problem. 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.
  6. 6. Determinants and Risk Factors :-Determinants and Risk Factors :- AGE :- caries is considered a childhood disease, it increase sharply in youth & early adults. 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 outer surfaces.
  7. 7. 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 visits, which considered as treatment factor.
  8. 8. 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.
  9. 9. 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.
  10. 10. SES differences means differences in :- Education. Self care practices. Attitudes. Values. Available income. Access to health care.
  11. 11. 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.
  12. 12. Diet, Nutrition, and Caries :-Diet, Nutrition, and Caries :- Diet : Refers to the total oral intake of substance that provide nourishment and energy. Nutrition : Refers to the absorption of nutrients . So, Nutritional Counseling is more correctly referred to as Dietary Counseling.
  13. 13. 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 ).
  14. 14. 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 etiological factor . 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.
  15. 15. 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 between meals. Conclusion:- Sugar consumption increase caries. The risk increases if sugar is in sticky form, and taken between meals.
  16. 16. 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 dietary CHO.
  17. 17. it is recommended to it is recommended to finish a meal with finish a meal with fibrous salivary fibrous salivary stimulant such as stimulant such as AA carrot carrot OrOr an applean apple
  18. 18. 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.
  19. 19. Microbial agent Dental caries is a bacterial disease. Regardless of any other factor, caries cannot occur in the absence of bacteria.
  20. 20. •Dental caries is a transmissible infectious disease as cariogenic bacteria usually passed along from mother to infant.
  21. 21. 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 tooth surface.
  22. 22. 2- Store intra-cellular polysaccharides which act as a transient reserves of fermentable carbohydrates. 3- Fermentation of dietary carbohydrates as an energy source for its metabolic activity and produces lactic acid.
  23. 23. 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 drink. More prevalent in low SES population, where infants are being cared by little educated mothers. Prevention based on education of parents.
  24. 24. 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 plaque. Strongly associated with :- Age SES Loss of periodontal attachment Number of remaining teeth Use of dental services Oral hygiene level Preventive behavior.
  25. 25. 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.