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Epidemiology Of Dental Caries

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Epidemiology Of Dental Caries * * * The host Risk Factors 1- Age. 2- Gender. 3- Race. 4- Genetic & familial. 5- Role of saliva. – PowerPoint PPT presentation

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Title: Epidemiology Of Dental Caries


1
Epidemiology Of Dental Caries
2
Epidemiology of dental caries
3
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.

4
Low Caries incidence existed in Ancient Man
  • Examination of ancient skulls shows that

5
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.

6
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.

7
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.

8
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.

9
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.

10
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.

11
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.

12
  • 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.
13
  • 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.

14
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.

15

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.

16
  • 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.

17
  • 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.

18
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).

19
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)
  • ,.

20
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.

21
II-Susceptibility of different teeth
  • Dental caries in the human mouth is usually
    distributed in a bilateral symmetry.

22
Susceptibility Of Different Teeth
  • According to the pioneering Hagerstown studies
    (1937), the rank order of susceptibility of teeth
    to caries was listed as follows

23
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.
5
24
Determinants risk factors
dental caries
25
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.

26
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.
27
Microbial agent
  • Dental caries is a bacterial disease.
  • Regardless of any other factor, caries does not
    occur in the absence of bacteria.

28
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)

29
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.

30
  • 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.

31
Streptococcus mutans
32
  • Lactobacilli could be considered as secondary
    contributors for the process.
  • They generally constitute less than 1 of the
    plaque microbiota.

33
  • 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.

34
The host Risk Factors
  • 1- Age.
  • 2- Gender.
  • 3- Race.
  • 4- Genetic familial.
  • 5- Role of saliva.
  • 6- Nutrition
  • 7-Systemic diseases and drugs.

35
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.

36
Age
  • In communities with lower attack rate, young
    people reach adulthood with most surfaces caries
    free and caries attack spread out more throughout
    life.

37
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.

38
  • After age of 60 years, caries increases again
    because of root caries.

39
Gender
  • It is observed that caries prevalence is higher
    in females than in males of the same age.

40
  • 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.

41
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.
    .

42
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.

43
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.

44
  • 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).

45
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.

46
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.

47
  • 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.

48
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.

49
  • 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.

50
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 .

51
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).

52
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.

53
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.

54
Systemic diseases and drugs causing diminished
salivation (xerostomia) .
55
Causes of xerostomia
  • 1. Drugs/medications
  • Analgesics
  • Antiarthritic
  • Antispasmodic (gastrointestinal)
  • Antidepressant
  • Antidiarrheal
  • Antihistaminic
  • Antihypertensive

56
  • 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)

57
Environmental Risk Factorsof Dental Caries
  • Diet
  • Diet refers to the total intake of substances
    that provide nourishment and energy.

58
Diet
  • Diet refers to the total intake of substances
    that provide nourishment and energy.

59
Balanced Diet
  • It is one which contains all nutrients in such
    quantities and proportions so as to fulfill the
    need of calories.

60
Diet
  • Intake of refined carbohydrates especially
    sucrose (sugar) is considered a strong etiologic
    factor in the causation of dental caries.

61
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.

62
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.

63
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.

64
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.

65
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