toutouni 1 .dental caries

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Dr.Toutouni


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DENTAL CARIES

Dr.Toutouni


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OVERVIEW

DESCRIPTION & HISTORY

MEASUREMENT

DIAGNOSING CRITERIACARIES FREE

DISTRIBUTION

SECULAR VARIATIONS IN

CARIES EXPRIENCE

DEMOGRAPHIC RISK

FACTORS

BIOLOGIC & ENVIROMENTAL

RISK FACTORS & RISK

INDICATORS

ROOT CARIES

EARLY CHILDHOOD CARIES

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Description

Dental caries is a mutifactorial disease that dissolve

and destroy mineralized dental tissues.

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MICROORGANISMS SUBSTRATE

TIMEHOST & TEETH


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History ( Measurement):

From early Twentieth century:

1- Proportion of lost molars through caries

2-The percentage of erupted permanent teethaffected by caries

Problem: Lack of sensitivity

Bodeckers index: decayed surfaces

Problem: Complicated

Forerunner of DMF index: Dean

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INDICES

DISEASE

DMF INDEX

dmf

def

df

SiC INDEX

GRAINGERS HIERARCHY

HEALTH

CAREIS FREE PERCENTAGE

FS-T INDEX

T-HEALTH INDEX

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DMF INDEX:

Applied only to permanent teeth

D Decayed,

M Missing due to caries,

F FilledDMF score for a group: The sum of individual values

The number of subjects examined

Can have a Decimal value (continuous numerical scale)

For all teeth: DMFT, For surfaces: DMFS

Modifications: Recurrent caries, Crowned teeth, Bridgepontics , Sealed teeth DMFST, DMFSS

In large a survey: Half mouth

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Limitations:

No at risk teeth

No denominator

No declaration of

intensity of attack

Should be stated with

age

equal weight to D,M, F

Little estimation of

treatment needs

Should be stated with

caries free percent

Recall bias

Overestimation

Compress extremevalues

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SiC INDEX:

Significant caries indexDescription: The mean ofthe extreme values

of DMF index( In one- third of the population)

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Health indices:

FS_T index

The sums of the sound

and healthy restored

teeth

T-Health index

Measure the amount of

healthy dental tissue

Assigns descending numericalweight for a sound tooth,

Filled tooth, Decayed tooth

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Dr.Toutouni

New rankFS-TDMFTDMF rankCountry

1619.98.31Afghanistan

2019.292Guinea(New)

423.89.45Italy

125.614.722Austria

224.213.720Japan


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Criteria for diagnosing caries:

0.Surface sound: No treated or untreated caries( slight staining)

D1.Initial caries: No clinically detectable loss of substance( sig

staining in pit and fissures, discoloration, rough spots in

enamel)D2. Enamel caries: Demonstrable loss of tooth substance in pits,

fissures, smooth surfaces , no softened floor and wall or

undermined enamel.

D3. Caries of Dentin: Detectably softened floor, underminedenamel, softened wall or temporary filling

D4.Pulpal involvement: Deep cavity with probable pulpal

involvement, pulp should not be probed.

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CASE ONE:

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CASE TWO:

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CASE THREE:

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CASE FO

UR:


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CASE FIVE:

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CASE SIX:

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Criteria

Pits and fissures are caries when:

Opacity to the adjacent area providing evidence ofundermining or demineralization.

Softened enamel adjacent to the area that may bescraped by the explorer

Visual method vs Visual- Tactile method

A good proportion ofnoncavitated lesionsremain static or even remineralize especiallysmooth surface lesions.

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cariesNew methods in diagnosing

Fiberoptic transillumination

Electrical conductance

Laser fluorescenceAdvantages:

Do not change the approach to measuring caries

Detect non-cavitated lesions at an early stages

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Hidden caries

Dentinal caries found radiographically beneath

apparently sound occlusal surface

Rare condition:7.5% in Dutch and 2.5% in Lithuanian

By- product of fluoride age

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Caries free

Free of caries requiring restorative treatment

Activities like early demineralization-

remineralization cycles, white spots, stained fissuredoes not progress

without obvious lesion

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History ( Disease):

Fifth to Seven centuries: Moderate caries experience

More attrition, cervical & root caries

Uncommon coronal caries

Sixteenth century: Modern pattern ( Fissured &

Proximal surfaces), in High-income nations

Eighteenth century: Dietary changes

The expansion : 1845-1875

The end ofnineteenth century: Endemic disease

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DISTRIBUTIONMost obvious reason : Diet

For most of the 20th century:

Disease of the High- income countries

Low prevalence in poorer countries

By the late 20th century:

Sharply rising caries in low-income countries after world

war II (1939-1945)

Significant caries reduction in high-income countries

Most data : DMFT

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SECULAR VARIATTIONS IN CARIES EXPERIENCE:

More affected teeth were attacked within 2-4years after eruption

Early 1980s: The greatest reduction in caries

prevalence

As caries prevalence falls:

The least susceptible sites(proximal & smooth

surfaces) The greatest proportionThe most susceptible sites( occlusal) The

smallest proportion

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POLARIZATION

Most caries occurs in relatively small number of

children of the same age

60%

of all affected teeth are found in about 20%

of children

Three- Fourth of all affected teeth are found in

One- Fourth of the children

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DEMOGRAPHIC RISK FACTORS:

Age

In future: DMFT in all ages, M in adults, M & F

in younger

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DEMOGRAPGIC RISK FACTORS:

Gender: Higher DMFT score in womenReasons: Earlier eruption of teeth

Treatment factor

Race & Ethnicity: white race has higher F,

lower D & MHigher DMFT in minorities

Dr.Toutouni

In the same age, D &M

are equal in men &

women, but higher F in

women


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:DEMOGRAPHIC RISK FACTORS

Socioeconomic status:

Social class is classified by: years of education, annualincome, occupation, place of residence

Reversely related to incidence of diseasesIn minorities: Higher SES Higher DMFT

Familial & Genetic patterns : No transmissionby Genetics

Husband- wife similarities

Mother to infant (window of infectivity)

Just Form & Shape of the teeth

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BIOLOGICAL RISK FACTORS & RISK

:INDICATOR

Bacterial infection:

No bacteria, No caries

Caries: ecologic imbalance

Diet

Nutrition

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ROOT CARIES:

Root caries is defined as caries that begins on cemental

root surfaces below the cervical margin.

Is found only where loss of periodontal attachment is

present.

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ROOT CARIES:

Importance in community dentistry: AGING

Geriatrics is a new field in community dentistry

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RISK FACTORS :

Loss of periodontalattachment

Socioeconomic status

Number of remainingteeth

Use of dental services

Oral hygiene levels

Preventive behaviorMultiple medication

Radiotherapy

Wearing partial denture

Sucking candies in a drymouth

Living in an institutionHigher coronal caries

Gingival recession

Low-Fluoride areas

SmokingRace

Xerostomia

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ROOT CARIES:

Root Caries Index:

(Root surfaces: decayed + filled)* 100

(Root surfaces with loss of periodontalattachment: decayed + filled + sound)

Problems : It does not take into account the time,Sub gingival lesions.

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EARLY CHILDHOOD CARIES:

Presence of any decayed surface in children

under 72 months.Most involved teeth: primary incisors &molars

It is more prevalent in: Minorities( 70%),

Deprived & Low SES ,LBW children, Chroniccariogenic diet.

Importance in Community dentistry: Difficult

& Costly treatmentDr.Toutouni


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EARLY CHILDHOOD CARIES:

Labial caries, Baby Bottle Tooth Decay, Nursing

caries,

13%- 36% in IRAN ( under 6 years old, in 1386)

Like Australia, Belgium, Hispanic

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THANK YOU

ANY QUESTION?

toutouni 1 .dental caries

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