EPIDEMIOLOGY OF EPIDEMIOLOGY OF DENTAL CARIES :-DENTAL CARIES :-

PROF.AHMED ABD EL PROF.AHMED ABD EL RAHMANRAHMAN

Host

1- Age.

2- Gender.

3- Race.

4- Genetic &familial.

5- Local host factors.

Agent

1- Streptococcus mutans.

2- Lactobacilli.

3- Other microorganism.

Environmental

1-Flouride.

2-Trace.

3-Water hardness.

4-Nutrition&diet.

5-Social factors.

6-Local oral environmen.

7-Climatological factors.

Multifactorial inter-action in the etiology of dental caries.

Food

com

pone

nts

Bacterial plaque

Local

host

factors)

teeth &

saliva(

GLOBAL DISTRIBUTION :-GLOBAL DISTRIBUTION :-

During most of the 20th centuryHigh prevalence developed

countriesLow 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.

BY THE 20BY THE 20thth CENTURY, CENTURY, PATTERN WAS CHANGEDPATTERN 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.

Determinants and Risk Factors :-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.

GENDER :-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.

Race and Ethnicity :-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.

Socio-economic status (SES)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.

SES differences means differences in :-

Education. Self care practices.

Attitudes. Values.

Available income. Access to health care.

Familial and genetic pattern :-Familial and genetic pattern :-

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

Diet, Nutrition, and Caries :-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.

Prior to modern preventive Prior to modern preventive methods :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 ).

Dietary factors by contrast with Dietary factors by contrast with nutritional adequacy :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.

Vipeholm study ( 1945-1952 )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.

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.

it is recommended to

it is recommended to

finish a meal with

finish a meal with

fibrous salivary

fibrous salivary

stimulant such as

stimulant such as

AA carrot

carrot

OrOr an applean apple

British and U.S. studies British and U.S. studies (1980) :-(1980) :-

Consumption of sugar is not a major risk factor, but for those who are susceptible to caries.

Caries is a multi factorial disease.

Microbial agent

Dental caries is a bacterial disease.

Regardless of any other factor, caries cannot occur in the absence of bacteria.

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

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.

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.

Nursing caries :-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.

Root caries :-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 SESLoss of periodontal attachmentNumber of remaining teethUse of dental servicesOral hygiene levelPreventive behavior.

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.