EPIDEMIOLOGY OF DENTAL CARIES :-

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EPIDEMIOLOGY OF DENTAL CARIES -

• PROF.AHMED ABD EL RAHMAN

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Host
Agent
Environmental
1-Flouride. 2-Trace. 3-Water hardness. 4-Nutrition
diet. 5-Social factors. 6-Local oral
environmen. 7-Climatological factors.
1- Age. 2- Gender. 3- Race. 4- Genetic
familial. 5- Local host factors.
1- Streptococcus mutans. 2- Lactobacilli. 3-
Other microorganism.
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Multifactorial inter-action in the etiology
of dental caries.
no caries
no caries
other
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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.

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BY THE 20th CENTURY, PATTERN 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.

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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.

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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.

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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.

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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.

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SES differences means differences in -

• Education. Self care practices.
• Attitudes. Values.
• Available income. Access to health care.

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Familial and genetic pattern -

• Familial tendencies are seen, may be due to
  genetic basis or bacterial transmission or
  continuing familial dietary or behavioral traits.

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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.

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Prior to modern preventive 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 ).

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Dietary factors by contrast with 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.

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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.

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• 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.

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it is recommended to finish a meal with fibrous
salivary stimulant such as
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British and U.S. studies (1980) -

• Consumption of sugar is not a major risk factor,
  but for those who are susceptible to caries.
• Caries is a multi factorial disease.

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Microbial agent

• Dental caries is a bacterial disease.
• Regardless of any other factor, caries cannot
  occur in the absence of bacteria.

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• Dental caries is a transmissible
• infectious disease as cariogenic
• bacteria usually passed along
• from mother to infant.

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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.

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• 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.

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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.

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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.

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• 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.