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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Dental Caries

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