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Measuring Dental Caries


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Community Dentistry
Third Year

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Measuring Dental Caries

  1. 1. ‫بسم ال الرحمن الرحيم‬ Measuring dental caries Introduction to Community Dentistry PDS 372
  2. 2. Lecture outline      DMF index Criteria for diagnosing coronal caries Root caries Early childhood caries Caries treatment needs
  3. 3. Pathogenesis of Dental Caries (biological balances) SALIVA PLAQUE PLAQUE ENAMEL ENAMEL Polysaccharides Calcium Salts Plaque buffers mouth SUGARS inside of tooth ACID Calcium Salts Bacterial Enzymes Salivary buffers Demineralization Re-mineralization
  4. 4. Methods of measuring dental caries in the early 20th century:  The proportion of first molars lost through caries  The percentage of erupted permanent teeth affected by caries
  5. 5.    Bodecker’s index Dean and colleagues count Klein, Palmer and Knutson DMF index
  6. 6. DMF index     Universal acceptance Best known and most widely used dental index What is an index? Is a numerical scale with upper and lower limits, with scores on the scale corresponding to specific criteria
  7. 7. Properties of an ideal index       Validity Reliability Clarity, simplicity, and objectivity Quantifiability Sensitivity Acceptability
  8. 8. DMF index      Is an irreversible index Applied only to permanent teeth D M F
  9. 9. DMF index        It ranges from 0 to 32 Decimal DMF DMFT vs. DMFS Modifications can be made Half mouth approach 32 teeth vs. 28 teeth DMF vs. def
  10. 10.    The DMFT index is one of the simplest and most commonly used indices in epidemiologic surveys of dental caries. It quantifies dental health status based on the number of carious, missing and filled teeth . The index, however, does not provide an accurate description of previous dental care . Nor does it provide information regarding the severity of the carious attack or the indicated treatment .
  11. 11. Limitations of the DMF index  DMF values are not related to the number of teeth at risk        It has no denominator Age must be stated DMF index gives equal weight to missing, untreated decayed, and well-restored teeth DMF index is invalid when teeth have been lost for reasons other than caries DMF index can overestimate caries experience in teeth with “preventive restorations” DMF data not useful for estimating treatment needs DMF index can not account for sealed teeth
  12. 12. def index   Teeth missing because of caries are not recorded Modifications to this index includes: It should be used in children before the age of exfoliation  Applied to only primary molars  The df index 
  13. 13. DMF index   Because of the present day skewed distribution of dental caries prevalence, the Significant Caries Index (SiC Index) was developed A global goal of an SiC score of 3.0 or less for 2015
  14. 14. Other teeth indices      Grainger’s hierarchy, an ordinal scale with 5 zones of severity attack FS-T, sums the sound and healthy restored teeth T-Health, measures healthy dental tissues and assigns descending numerical weights Sealed teeth DMFS vs. DMFSS A measure of caries activity vs. treatment received
  15. 15. Criteria for diagnosing coronal caries        Cavitated vs. non-cavitated Borderline lesions Reversible vs. irreversible Dentinal vs. enamel caries Visual-tactile vs. visual only The use of radiographs Latest technologies in caries detection
  16. 16. Criteria for diagnosing coronal caries       Diagnosis through the full range of caries, the D1-D3 scale: 0. Surface sound D1. Initial caries D2. Enamel caries D3. Caries of dentin D4. Pulpal involvement
  17. 17. Criteria for diagnosing coronal caries   1. 2. 3. Diagnosis at the dental lesion stage only, the dichotomous scale: Catches that are accompanied by: Softness at the base of the area Opacity adjacent to the area Softened enamel adjacent to the area
  18. 18. Terminology for dental decay (caries) established decay decay into dentine obvious decay experience (%d3mft/D3MFT) Unseen dentine decay early stage decay very early stage decay Visible enamel decay Sub-clinical decay Unseen enamel Decay excludes all enamel lesions
  19. 19. Recording visual caries at the dentine level SIMPLER TERMS DENTISTS’ TERMS Traditional indicator now termed: severe decay Pulpal decay obvious decay into dentine established decay Dentine decay Unseen dentine decay Groups and Individuals with “No Obvious Decay” should NOT be called “Caries Free” Proportion with no obvious decay experience
  20. 20. Root caries
  21. 21. Root caries  Criteria for diagnosing root caries  Root caries activity, the Root Caries Index (RCI) scores (Root surfaces: decayed + filled) X 100 / (Root surfaces with loss of periodontal attachment: decayed + filled + sound) 
  22. 22. Early childhood caries
  23. 23. Early Childhood Caries       Baby bottle tooth decay Nursing caries Labial caries Dietary associations Exposure to sugar Case definition
  24. 24. Early childhood caries Ages in months ECC Severe ECC <12 1 or more dmf surfaces 1 or more smooth dmf surfaces 12-23 1 or more dmf surfaces 1 or more smooth dmf surfaces 24-35 1 or more dmf surfaces 1 or more smooth dmf surfaces 36-47 1 or more dmf surfaces Anterior teeth involved and dmfs ≥ 4 48-59 1 or more dmf surfaces Anterior teeth involved and dmfs ≥ 5 60-71 1 or more dmf surfaces Anterior teeth involved and dmfs ≥ 6
  25. 25. Caries treatment needs   The D component of the DMF should be the guide for treatment Not suitable for the following reasons: Survey vs. clinical criteria  Patients’ perceived needs and willingness to pay for treatment  Judgment over the caries activity  Treatment philosophies change with time 
  26. 26. Caries treatment needs    Caries assessment in the field vs. the clinic The WHO includes a subjective treatment need assessment by the examiner as part of the pathfinder survey method A situation analysis in low-income countries
  27. 27. Questions?