The document describes Cariogram, a model that graphically illustrates an individual's risk for dental caries using a pie chart divided into sectors representing biological, dietary, and other risk factors. It aims to estimate caries risk and encourage preventive measures. The size of the green "Chance to Avoid Caries" sector indicates the likelihood of avoiding new cavities based on the proportions of the red, blue, yellow, and light blue sectors for bacteria, diet, circumstances, and susceptibility respectively.

3.  Cariogram is a model proposed by Bratthall D in 1996 to illustrate interaction
between bacteria, diet and host response.
 It is a new way in which to illustrate the interaction between caries related
factors.
 This educational interactive program has been developed for better
understanding of the multifactorial aspects of dental caries and and to act as a
guide in the attempts to estimate the dental caries.
 The main purpose of the cariogram is to demonstrate the caries risk graphically,
expressed as the “Chances to avoid new caries”.
 A further purpose of this program is to encourage preventive measures to be
introduced before new cavities could develop.

4.  Dental caries is defined as an infectious microbiological disease of teeth that
results in localized dissolution and destruction of the calcified tissue.
 The word caries is derived from Latin, meaning ‘rot’ or decay.
 There is presently an alarming rate of increase in the prevalence of dental caries
in developing countries.
 The relationship between diet and dental caries is characterised by the following
equation:
Bacterial enzyme+Fermentable carbohydrates=Acid
Acid+Enamel=Dental Caries

5.  Risk is often defined as the probability of an ‘unwanted’ event occurring within a
specified period of time.
 Caries risk is the probability that an individual will develop carious lesions,
reaching a given stage of the disease in progression during a specified period of
time.
 Thus caries risk relates to the likelihood of a person developing carious lesion or
not.
 The need for predicting the caries risk accurately is obvious, as targeted
preventive actions can be directed to those having a high caries risk, before
cavities could develop
 Naturally, if the main etiological factors could be identified, suitable treatment for
that particular individual can be carried out with good results.

6. Children and older individuals
Lower economical status
Lower education
Low fluoride exposure
Poor General health

7.  Illustrtes the interaction of caries related factors.
 Illustrates the chances to avoid caries .
 Expresses caries risk graphically.
 Recommends targeted preventive actions .
 Can be used in the clinic.
 Can be used as an educational program.

8. The pie circle diagram is divided into 5
sectors:
1. RED- “Bacteria”
2. DARK BLUE- “Diet”
3. LIGHT BLUE- “Susceptibility”
4. YELLOW- “Circumstances”
The four sectors are mapped out and what
is left is the
5. GREEN- “Chances to avoid caries”

9. RED SECTOR- BACTERIA
 The red sector ‘Bacteria’ is based on a combination of amount of
plaque and mutant streptococci.
 High S.Mutant count
Low S.Mutant count
High risk
Low risk
• Thick plaque on tooth surfaces enhances carious process by:
1. Shielding the bacterial from buffering effect of saliva at tooth-
plaque interface.
2. Preventing remineralization.

10. DARK BLUE SECTOR- DIET
 The most common cause of caries is ingestion of carbohydrates BUT
not all patients with high sugar intake will develop caries.
 The cariogenicity of dietary carbohydrates varies with:
1. Frequency of ingestion: More frequency= more caries.
2. Physical form: Sticky solid carbohydrates > liquid carbohydrates.
3. Time of Ingestion: In between meals > with meals.

11. LIGHT BLUE SECTOR-
SUSCEPTIBILITY
 The light blue sector ‘Susceptibility’ is based on a combination of fluoride
program, saliva secretion and saliva buffer capacity.
1. Fluoride program
 Fluoride present in low, sustained concentrations (sub-ppm range) in the oral
fluids during an acidic challenge is able to absorb to the surface of the apatite
crystals, inhibiting demineralization.
 However, excessive fluoride intake during the period of tooth development can
cause dental fluorosis.
2.Saliva secretion
 High level of salivary flow  cariostatic effect.
 Xerostomia or dry mouth  Favourable environment for dental caries.

12. 3. Saliva buffer capacity
• The buffering capacity of saliva is very significant property that
affects the dental caries process.
• The bicarbonate in saliva is able to diffuse into the dental plaque to
neutralize the acid formed from carbohydrate by the
microorganisms.
• Saliva also contains Calcium and Phosphorus which enhances
remineralization.

13. YELLOW SECTOR-
CIRCUMSTANCES
 The yellow sector ‘circumstances’ is based on the combination of past caries
experience and reacted diseases.
1.Past caries experience
 DMFT and DMFS are means to numerically express the caries prevalence and
are obtained by calculating the number of Decayed (D), Missing (M) and Filled (F)
teeth (T) or surfaces (S).
 It is thus used to get an estimation illustrating how much the dentition so far
has become affected by dental caries. Usually, it is calculated on 28 teeth, excluding
18, 28, 38 and 48 from the index

14. 2. Related diseases
• Several general diseases or conditions can directly or indirectly influence
the
caries process, either through affecting saliva formation and composition,
through a
caries-inducing dietary pattern or through medicines.
• Diseases or conditions in early childhood may have influenced the
formation of the enamel.
For example:
Autoimmune diseases, like Sjogren's syndrome.
Intake of medicines.
Radiation towards the head-neck region.
• Other problems and handicaps should be taken into consideration. For
example, poor eye-sight may affect correct oral hygiene measures.
Handicapped
patients could have difficulties in cleaning their teeth properly

15. THE GREEN SECTOR-
CHANCE
 The bigger the green sector, the better it is from dental health point
if view.
 Small green sector means low chances of avoiding caries = high
caries risk.
 For the other sectors, the smaller the sector, the better it is from a
dental health point of view.

21. CONCLUSION
 The importance of properly predicting the occurrence of lesions is obvious as
targeted preventive actions can be directed to those persons having a high risk
for
caries, and scarce resources can be properly utilized. In addition, as dentistry
moves
toward earlier detection of lesions and a more preventive, rather than
restorative,
Orientation.
 In addition to that, it can give valuable hints and may serve as a basis for
treatment planning of particular patient and preventive strategies needed for
each patient.