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‫بسم ال الرحمن الرحيم‬

Measuring dental
caries
Introduction to Community Dentistry
PDS 372
Lecture outline






DMF index
Criteria for diagnosing coronal caries
Root caries
Early childhood caries
Caries treatment needs
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
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




Bodecker’s index
Dean and colleagues count
Klein, Palmer and Knutson DMF index
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
Properties of an ideal index







Validity
Reliability
Clarity, simplicity, and objectivity
Quantifiability
Sensitivity
Acceptability
DMF index







Is an irreversible index
Applied only to permanent teeth
D
M
F
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





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 .
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
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

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
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
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
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
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
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
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
Root caries
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)


Early childhood caries
Early Childhood Caries







Baby bottle tooth decay
Nursing caries
Labial caries
Dietary associations
Exposure to sugar
Case definition
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
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

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
Questions?

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Measuring Dental Caries

  • 1. ‫بسم ال الرحمن الرحيم‬ Measuring dental caries Introduction to Community Dentistry PDS 372
  • 2. Lecture outline      DMF index Criteria for diagnosing coronal caries Root caries Early childhood caries Caries treatment needs
  • 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. 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.    Bodecker’s index Dean and colleagues count Klein, Palmer and Knutson DMF index
  • 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. Properties of an ideal index       Validity Reliability Clarity, simplicity, and objectivity Quantifiability Sensitivity Acceptability
  • 8. DMF index      Is an irreversible index Applied only to permanent teeth D M F
  • 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.    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. 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. 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. 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. 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. 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. 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. 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. 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. 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
  • 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) 
  • 23. Early Childhood Caries       Baby bottle tooth decay Nursing caries Labial caries Dietary associations Exposure to sugar Case definition
  • 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. 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. 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