Dental Caries in Relation to Public Health

Heather K. Blair, RDH, BSDHMPH 500, Fundamentals of Public HealthConcordia University of NebraskaOctober 20, 2013Fall Semester

Presentation Overview•Epidemiology•Environmental Factors•Biomedical Basis•Biostatistics•Social & Behavioral Factors•Policy •References

“Dental Caries affect 60% to 90% of school children and almost 100% of adults, and is the most common chronic disease affecting children and adolescents” (Yokoyama et al., 2013)

EpidemiologyRisk Factors

• Congenital Enamel/Tooth Defects – Amelogenesis imperfecta, enamel hypoplasia

• Virulent Bacteria - (Streptococcus mutans & Streptococcus sobrinus)

• Biologic Variation – genetic tendency, heredity, host susceptibility

• Age, Race, Gender

• Dietary Habits

• Dental Care – home & professional (Burt & Eklund, 2005)

Environmental Factors

Risk Factors

•Social Environment – Educational level of family, cultural beliefs & quality of neighborhood

• Physical Environment – fluoride exposure

•Lifestyle – use of tobacco or exposure 2nd hand

•Physical Activity Level

(Burt & Eklund, 2005) VS.

Why do some people have cavities and others do not?

•Dental caries is a bacterial infection that is the product of a combination of multiple variants coming together in the right ways to produce cariogenic activity.

In laymen’s terms dental caries is –the result of a susceptible host/tooth +cariogenic bacteria + dietary fermentablecarbohydrates which form acid and if not removed in a timely manner may create a hole in a tooth. (Darby & Walsh, 2003)

Have you ever heard anyone say, “I have soft

teeth”?This means that they have inherited a genetic predisposition for dental caries. Not soft teeth.

Enamel is the “hardest tissue of the body; its mineral content far exceeds the mineral content …. of bone(50%)” (Melfi & Alley, 2000)

Example of Host Susceptibility

Virulent BacteriaThe mouth is the perfect

place bacteria to grow.

The bacteria most associated with dental caries is Streptococcus mutans and Streptococcus sobrinus (Wilkins,

2005)

Why? It is warm, dark and wet! Teeth are great to hide around.

Frequency vs. Quantity• For bacteria to grow – they

must have food.

• Oral bacteria eat fermentable carbohydrates

• When we eat, the bacteria eats

Ex: Someone says, “I only drink one Coke a day.”

If they open it at8:00am whenthey get to theirdesk and finishit at 5:00pmwhen they leave, they bath their teeth in that

sugaryacidic liquid and their teeth

neverget a break to bring the pH

back toa neutral state.

Measuring Dental CariesQuantitative Data Qualitative Data

Screening Tools

DMFT index (adults) – Decayed, Missing, Filled Teeth

deft index (children) –decayed, extracted, filled teeth

RCI – root caries index

ECC – early childhood caries

Examples of measurable data.

(Burt & Eklund, 2005)

Examples that give meaning tothe data and answers the “why”

Personal interviews –

Reviewing medical histories

Talking with patient/caregiver

Socioeconomic status

Observations

Perceived risk by the dental professional

Understanding traditions (Tinanoff, Kanellis & Vargas,

2002)

Biomedical Basis of Dental Caries

It’s all about the bacteria!

Bacteria in the mouth is found in an oral biofilm.

Biofilm – “a well-organized community of bacteria that (i) adheres to surfaces and (ii) is embedded in an extracellular slime layer.” (Nield-Gehrig & Willmann, 2008)

Oral biofilm is difficult to culture in a lab (Hiyari & Bennett, 2011)

Oral Biofilm & Dental Caries• Clean teeth are covered by a salivary glycoprotein film called the acquired pellicle (Hiyari &

Bennett, 2011)

• The acquired pellicle is what the oral biofilm attaches to (Do et al., 2013)

• The bacteria associated with dental caries is usually gram + (Hiyari & Bennett, 2011)

• “Dental caries is a chronic, dietomicrobial, sit specific disease caused by shifts from protective factors favoring tooth remineralization to destructive factors leading to demineralization”. (Zero et al., 2009)

Where does this bacteria come

from?The initial introduction of bacteria is during infancy.

- tasting food checking for temperature - cleaning a pacifier with caregivers mouth - kissing the baby (ADA, 2013)

Later in life –

-Kissing can transfer bacteria from one person to another.

Current Research on Oral Bacteria Some describe the mouth as the window to the rest of

the body. Research is showing a strong correlation between oral disease and systemic disease.

• Cardiovascular disease

• Low Birth Weight Babies

• Diabetes

http://jada.ada.org/content/137/suppl_2/5S.fullhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC88948/

(Maltz, Jardim & Alves, 2010)

Biostatistics & Dental Caries

U.S. Surgeon General in the NHIS wanted to call attention to the “silent epidemic” of dental and oral diseases suffered by millions of children and adults throughout the United States. (Bloom et al., 2012)

NHANES survey noted:

75% of people have had a history of dental decay that have been restored through the use of amalgam, composite or crowns.

1 in 5 people have untreated decay.

Untreated decay varied between different socioeconomic groups. (Dye, Li & Beltran-Aguilar, 2012)

Social & Behavioral Factors According to the Ecological Model of Health

Behavior:

Individual - focuses on the individual’s knowledge, attitude, skills and value in maintaining optimum oral health and dental caries prevention.

Oral healthcare providers work with patients to review:

- Frequency of brushing- Frequency of flossing- Use and benefits of Fluoride- Importance of maintaining regular preventive visits

Patient’s risk for dental disease can be assessed through a:

- Clinical exam partnered with a radiographic exam- Caries Management by Risk Assessment Screening (CAMBRA)

(ADA, 2011)

Social & Behavioral Factors According to the Ecological Model of

Health Behavior:

Caries Management by Risk Assessment

(CAMBRA)

This allows the patient and oral healthcare provider to work together to determine the patients individual risk for dental caries and allows for treatment and homecare recommendations to be patient specific. (ADA, 2011)

Social & Behavioral Factors According to the Ecological Model of Health

Behavior:Motivational Interviewing –

This is a patient-centered counseling technique that is used in a non-threatening way through asking open ended questions that encourage the patient to talk and work through their own barriers.

(Freudenthal & Bowen, 2010)

Social & Behavioral Factors According to the Ecological Model of Health Behavior:

Interpersonal – focuses on families, friends and social networks.

Use – Prevent the potential transmission from parent to newborn, through oral health education prior to birth.

“..dental caries [is] the single most common chronic child-hood disease. In part, caries is rampant because early childhood caries (ECC) is a transmissible, infectious disease affecting

the teeth of infants and toddlers. Transmissibility is routed in the behavior of mothers or primary caregivers who expose

children to cariogenic microorganisms through intimate contact, sharing and tasting foods on a spoon or pacifier.”

(Freudenthal & Brown, 2010)

Social & Behavioral Factors According to the Ecological Model of Health Behavior:Organizational – focuses on organizations and social

institutions.

- Schools- Senior Housing- Assisted living facilities

- Correctional facilities - Rehabilitation facilities

Through health promotion there is the opportunity to share information regarding preventative care, risk factors and potential links between oral disease and systemic diseases. (Maltz, Jardim & Alves, 2010)

Social & Behavioral Factors According to the Ecological Model of Health Behavior:

Community – focuses on relationships within the community and between organizations.

Community partners include: Private dental offices Primary care offices Obstetrical practices Parenting education classes Refugee organizations Local politicians Medicaid – Transportation Public works department – Community water fluoridation

(CDC, 2013)

Social & Behavioral Factors According to the Ecological Model of Health Behavior:Public Policy – focuses on the National, State and Local

laws and regulations.

The government recognizes the evidence-based research that acknowledges the relationship between socioeconomic status and general health (NIH, 2013).

The government has been instrumental in the development of programs such as:

Women, Infants and Children (WIC)Influence over state Medicaid programsFederally Qualified Health Centers (FQHC) – developed to provide care in underserved areas. (HRSA, 2013)

* In the United States, “dental caries is the single most common childhood disease, occurring 5 times more frequently than asthma and 7 times more than hay fever” (Ditmyer et al., 2010).

* It is a multi-factorial disease that is affected by several variable risk factors.

* Dental caries is a disease that could potentially affect not only

the teeth, but systemic health as well. * There is a strong correlation between lower socioeconomic

status and increase rates of disease.

* Research is constantly being done to find the most accurate way to prevent dental caries.

* There are many avenues that oral health care providers may take to educate and interrupt the dental caries process.

Through the support from the government on a federal/state level, community partners, organizations and social institutions, interpersonal relationships and an individuals willingness to change there may be a break in the disparities that are currently present that are affecting oral health and dental caries.

Contact – Heather BlairHeather.Blair@cune.org

ReferencesADA, (2011). Caries Risk Assessment Form. [PDF Document]. Retrieved fromhttp://www.ada.org/sections/professionalResources/pdfs/topic_caries_over6.pdfADA. (2013). Mouth Healthy. Retrieved From http://www.mouthhealthy.org/en/babies-and-kids/healthy-habitsBloom, B., Simile, C., Adams., & Cohen, R. (2012). Oral Health Status and Access to Oral Health Care for U.S. Adults Aged 18-64: National Health Interview Survey, 2008. Retrieved from http://www.cdc.gov/nchs/data/series/sr_10/sr10_253.pdfBurt, B. A., & Eklund, S. A., (2005). Dentistry, Dental Practice, and the Community (6th ed.). St. Louis, Missouri: Elsevier SaundersCDC. (2013). Community Water Fluoridation. Retrieved from http://www.cdc.gov/fluoridation/CDC. (2013). National Health and Nutrition Examination Survey. Retrieved from http://www.cdc.gov/nchs/nhanes.htm Darby, M. L., & Walsh, M. M., (2003). Dental Hygiene Theory and Practice (2nd ed.). St. Louis, Missouri: SaundersDo, T., Devine, D., & Marsh, P. D. (2013). Oral biofilms: molecular analysis, challenges, and future prospects in dental diagnostics. Clinical, Cosmetic & Investigational Dentistry, 511-19. doi:10.2147/CCIDE.S31005Dye, B., Li, X., & Beltran-Aguilar, E. (2012). Selected Oral Health Indicators in the United States, 2005-2008. Retrieved from http://www.cdc.gov/nchs/data/databriefs/db96.pdfGeurink, K.V., (2005). Community Oral Health Practice for the Dental Hygienist (2nd ed.). St. Louis, Missouri: Elsevier Saunders Hiyari, S., & Bennett, K. M. (2011). Dental Diagnostics: Molecular Analysis of Oral Biofilms. Journal Of Dental Hygiene, 85(4), 256-263. Retrieved from http://uu4ga4xt9z.search.serialssolutions.com/?V=1.0&pmid=22309866HRSA. (2013). What are federally funded health centers (FQHCs)?. Retrieved from http://www.hrsa.gov/healthit/toolbox/RuralHealthITtoolbox/Introduction/qualified.htmlMelfi, R. C. & Alley, K. E., ( 2000). Tooth Enamel. McGrew, L. (Eds.), Permar’s Oral Embryology and Microscopic Anatomy (10th ed.) (pp. 81). Philadelphia, PA: Lippincott Williams & Wilkins Nield-Gehrig, J. S., & Willmann, D. E. (2008). Foundations of Periodontics for the Dental Hygienist (2nd ed.). Baltimore, MD: Lippincott Williams & WilkinsTinanoff, N, Kanellis, M. J., & Vargas, C. M. (2002). Current Understanding of the Epidemiology, Mechanisms, and Prevention of Dental Caries in Preschool Children. Pediatric Dentistry, 24:6, 543-549. Retrieved from http://www.aapd.org/assets/1/19/Tinanoff11-02.pdfWilkins, E. M., (2005). Clinical Practice of the Dental Hygienist (9th ed.). Baltimore, MD: Lippincott Williams & WilkinsZero, D. T., Fontana, M., Martinez-Mier, E. A., Ferreira-Zandona, A., Ando, M., Gonzalez-Cabezas, C., & Bayne, S. (2009). The Biology, Prevention, Diagnosis and Treatment of Dental Caries: Scientific Advances in the United States. JADA, 140. Retrieved from http://jada.ada.org/content/140/suppl_1/25S.full.pdf+html