Epidemiology Of Dental Caries

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Epidemiology Of Dental Caries
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Epidemiology of dental caries
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Dental Caries

• Dental caries is an ancient disease
  paleontological evidence shows that it has
  troubled humans from the time that agriculture
  replaced hunting as the principal source of food.

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Low Caries incidence existed in Ancient Man

• Examination of ancient skulls shows that

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Low caries incidence in the ancient man is due to
diet which was

• Comparatively low in carbohydrates.
• Natural (unrefined) diet.
• Coarse not fully prepared or cooked.

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Pattern Of Ancient Dental Caries

• The pattern of ancient caries as revealed by
  lesions in ancient skulls was mostly cervical or
  root caries and coronal caries was relatively
  uncommon.
• Coronal caries seemed to start in the occlusal
  fissures but developed no further because the
  rate of attrition was faster than the rate of
  progression.

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Pattern Of Ancient Dental Cariescont.

• The ancient pattern of dental caries was replaced
  in the 17th century by a new pattern where a
  lesion begins in fissured surfaces and develops
  later on proximal surfaces.
• This pattern took place in the industrialized
  nations as a result of the increased use of
  sucrose as sugars became more available.

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Current global distribution

• During most of the 20th
• century, dental caries
• pattern was
• High prevalence in developed countries higher
  socioeconomic group.
• Low prevalence in developing countries with less
  economic development.
• Caries was referred to as
• a disease of civilization.

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Global Distribution

• The most obvious reason for this historical
  pattern is diet the high level of consumption of
  refined carbohydrates in developed countries in
  contrast to diets low in fermentable
  carbohydrates in poorer societies where hunting
  and farming are the main source of food.

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Explanation of this pattern is
diet

• High level of consumption of refined
  carbohydrates in developed countries
  led to increase in cariogenic bacteria.
• Diet low in fermentable carbohydrates in
  developing countries surviving on farming
  hunting lower level of
  cariogenic bacteria.

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By the late 20th century, caries pattern was
changing in two ways

• 1- Sharp rising in caries prevalence and
  severity in most developing countries especially
  urban areas.
• 2- Marked reduction among children young
  adults in developed countries.

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• In both developed and developing countries ,
  there are distinct variations in caries
  experience from one country to another and from
  region to another within

The same Country.
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• The decline of caries is attributed to
• Use of fluoridated tooth paste.
• Fluoridation of water supplies.
• The use of fissure sealants.
• Implementation of preventive programs
• better access to health care
• better living conditions.
• Change of sugar consumption, although the change
  is not substantial.

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Global Distributioncont.

• upward trend of caries in many developing
  countries is related to
• The absence of widespread caries preventive
  strategy.
• Increasing consumption of sugar containing
  products.

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Variation of caries within the mouth

• The distribution pattern of dental caries closely
  follows that of plaque. Thus, the sites in the
  mouth which are most prone to caries are those
  where plaque accumulates.

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• These sites are
• 1. The fissures in the occlusal surfaces of
  molars.
• 2. The proximal areas.
• 3. The marginal area between the tooth and the
  gingiva.

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• I- Types of dental caries
• 1)Pit fissure caries
• It is the first to appear in the mouth.
• Pits fissure surfaces constitute the most
  susceptible surfaces in the mouth.

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2) Proximal caries

• It is the next to appear in the mouth.
• It is related to plaque accumulation in the
  non-self cleansing areas (beneath the contact
  points).

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3) Cervical caries

• Is the third type of dental caries that occurs
  uniformly throughout life.
• It is related to progressive changes in the free
  gingival margin, poor oral hygiene decreased
  salivary flow (xerostomia)
• ,.

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4) Root caries

• Occurs usually in old age (60 ylt).
• Root surfaces become exposed by gingival
  recession in advancing age.
• These exposed areas provide perfect areas for
  plaque accumulation.

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II-Susceptibility of different teeth

• Dental caries in the human mouth is usually
  distributed in a bilateral symmetry.

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Susceptibility Of Different Teeth

• According to the pioneering Hagerstown studies
  (1937), the rank order of susceptibility of teeth
  to caries was listed as follows

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Mandibular 1st 2nd molars
1
Max. 1st 2nd molars
2
Mand. 2nd,max. 1st 2nd premolars max. central
lateral incisors.
3
Max. canines mand. 1st premolars
4
Mand. Central lateral Incisors canines.
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Determinants risk factors
dental caries
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Dental Caries

• It is the disease of calcified tissues.
• It is a maltifactorial disease in which the
  following risk factors play role in its causation
  process
• Agent Microorganisms
• Host Personal and tooth risk factors.
• Environment Dietary, and oral hygiene related
  risk factors.

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Host
Environmental
Agent
1- Age. 2- Gender. 3- Race. 4- Genetic
familial. 5- Role of saliva. 6-
Nutrition 7-Systemic diseases and drugs.
1-Flouride. 2-diet. 3-Social factors.
1-Streptococcus mutans. 2- Lactobacilli. 3-
Actinomyces.
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Microbial agent

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

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Agent Factors of Dental CariesMicroorganisms

• Mainly Streptococcus mutans are responsible for
  initial development of dental caries with
  contribution of other species such as
• Lactobacillus acidophilus
• Lactobacillus casei
• Streptococcus salivarius
• Strpetococcus milleri
• Streptococcus sanguis
• Actinomycis (root caries)

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Strept. 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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Streptococcus mutans
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• Lactobacilli could be considered as secondary
  contributors for the process.
• They generally constitute less than 1 of the
  plaque microbiota.

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• Their number is often increased in caries active
  plaque because they grow well under acid
  condition.

• Lactobacilli are more a consequence than a cause
  of caries initiation.

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The host Risk Factors

• 1- Age.
• 2- Gender.
• 3- Race.
• 4- Genetic familial.
• 5- Role of saliva.
• 6- Nutrition
• 7-Systemic diseases and drugs.

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Age

• Caries was considered a childhood disease
  because all susceptible tooth surfaces become
  carious during early child years and few carious
  lesions are affected during adulthood.

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Age

• In communities with lower attack rate, young
  people reach adulthood with most surfaces caries
  free and caries attack spread out more throughout
  life.

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Age

• Caries increases progressively by age, and the
  increase is more slowly during adult years
• This is due to
• Most of the susceptible surfaces are likely
  to have been attacked by that time.
• The build up fluoride in outer layers of
  enamel over time.

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• After age of 60 years, caries increases again
  because of root caries.

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Gender

• It is observed that caries prevalence is higher
  in females than in males of the same age.

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• Females generally demonstrate higher
• DMF scores than males probably due to
• The earlier tooth eruption in females their
  teeth are at risk for a longer time.
• Females visit the dentist more frequently
  (treatment factor).
• The impact of these determinant, however has
  not been well quantified.

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Race

• Early studies, observed that some races as those
  in Africa India, had high degree of caries
  resistance than Europeans.
• Recently, the concept of racial differences have
  been faded, and the evidence reveals that the
  global differences are the result of environment.
  .

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Race

• This was supported by the fact that these racial
  groups, once thought to be resistant to caries
  (Africans and Indians), quickly developed the
  disease when they moved to areas with different
  cultural and dietary patterns.
• The variation in caries prevalence is the result
  of environmental rather than they are of racial
  attributes.

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Familial genetic pattern

• Dental caries has long ago shown to be grouped
  according to families.
• Members of the same household were found to be
  alike in their caries pattern than between
  unrelated groups of individuals.

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• Such familial tendency may be due to
• 1- Interfamilial bacterial transmission,
  especially from mother to baby.
• 2- similarity in dietary oral hygiene
  habits. OR,
• 3- Genetic factor as inheritance of tooth
  structure (deep narrow pits fissures) or
  special arch form (irregularities crowding).

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Socioeconomic status

• It is a measure of the individual background
  education, income, occupation, and attitudes and
  values.
• It is inversely related to the status of many
  disease.
• It is a powerful determinant of caries status in
  any community.

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Socioeconomic status

• Earlier studies found that higher SES groups had
  higher DMF scores than those in the lower SES
  groups.
• Details of DMF scores showed that lower SES
  groups had higher values for D and M, lower for
  F.
• Whereas, the increased number of filled teeth (F)
  raised the DMF index among the high SES groups
  treatment factor.

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• The difference between social groups is due to
  increased number of filled teeth (F) that raised
  the whole DMF index among high SES groups
  treatment factor.

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Socioeconomic Status (SES)

• With the reported caries decline, the DMF values
  of the higher SES groups became considerably
  below those in the lower SES group.
• The inverse relationship between caries status
  and SES have been reported from Britain and
  elsewhere in Europe.
• The same was reported in Africa.

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• Nutrition
• Nutrition refers to the absorption of nutrients
  and their utilization by the body cells for
  structural and functional efficiency.
• Nutrition can act only through the systemic
  route through influencing the host during tooth
  development.

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Nutrition and Dental Caries

• There is some evidence that chronic
  malnourishment during development periods in a
  poor society may predispose to caries.
• No relation between nutritional adequacy and DMF
  scores could be find.
• Vitamin D deficiency may cause enamel hypoplasia.
• Selenium Is a cariogenic trace element when
  consumed during tooth developmental period .

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Prior to modern preventive methods

• Caries prevalence was low in countries with low
  living standards, where generalized malnutrition
  was the norm.
• Current epidemiological evidence favors the
  conclusion that nutritional status does not
  directly influence the prevalence of dental
  caries (except for fluoride).

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Role of Saliva

• Diluting effect on fermented food residues.
• Buffering capacity to neutralize acid end
  products resulting from such fermentation.
• Provides ions for remineralization of early
  carious lesions.
• Provides antibacterial, antifungal and antiviral
  agents.

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Systemic diseases and drugs causing diminished
salivation (xerostomia) .

• Oral Symptoms
• Dry mouth (xerostomia)
• Thirst
• Difficulty in swallowing (dysphagia)
• Difficulty in speaking (dysphonia)
• Difficulty in eating dry food
• Need do drink water frequently at meals
• Difficulty in wearing
• dentures
• Frequent pain of the throat,
• simulating tonsillitis.

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Systemic diseases and drugs causing diminished
salivation (xerostomia) .
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Causes of xerostomia

• 1. Drugs/medications
• Analgesics
• Antiarthritic
• Antispasmodic (gastrointestinal)
• Antidepressant
• Antidiarrheal
• Antihistaminic
• Antihypertensive

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• 2. Irradiation particularly of the head and
  neck area.
• 3. Systemic diseases
• Rheumatoid conditions
• Psychogenic disorders (depression)
• Anorexia nervosa, malnutrition
• Menopause
• Salivary gland stones
• Aging (a contributory factor)
• Decreased masticatory activity (liquid diet, soft
  food)

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Environmental Risk Factorsof Dental Caries

• Diet
• Diet refers to the total intake of substances
  that provide nourishment and energy.

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Diet

• Diet refers to the total intake of substances
  that provide nourishment and energy.

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Balanced Diet

• It is one which contains all nutrients in such
  quantities and proportions so as to fulfill the
  need of calories.

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Diet

• Intake of refined carbohydrates especially
  sucrose (sugar) is considered a strong etiologic
  factor in the causation of dental caries.

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Diet and Dental CariesCariostatic effect

• Carbohydrate Sucrose is the most cariogenic
  carbohydrate.
• Protein High protein diet is cariostatic.
• Fat Fats are cariostatic.
• Phosphates Phosphates are cariostatic.
• Fluorides Increase the resistance of enamel to
  acid dissolution.
• Vitamin B6 (Pyridoxine) prevent dental caries by
  altering the microbial flora.

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Diet and Dental Caries

• Cariogenicity of the diet Sugars and
  fermentable carbohydrates are a major etiological
  factor in the causation of caries.
• Cleansing nature of the diet Accumulation of
  fermentable carbohydrates could be removed by
  eating hard and fibrous foods (detersive food).
• Salivary stimulation effect of the diet Food
  that induce salivary flow keeps the mouth free of
  fermentation.

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Sugar-Caries Relationship

• The role of sugar in dental caries is related
  to
• Frequency of consumption of sugars the risk
  increased if sugars are taken between meals.
• The frequency of consumption is of major
  importance.
• The nature of sugars the risk is greatest if the
  sugar is in sticky form.

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Environmental Risk Factors of Dental Caries

• Oral hygiene practices
• Poor level of personal oral hygiene maintained by
  the individual is considered an important
  environmental risk factor for dental caries.
• Healthy oral hygiene practices include thorough
  daily removal of dental plaque and other debris
  by toothbrushing, flossing and mouth rinsing.

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