Epidemiology of dental caries

EPIDEMIOLOGY OF DENTAL CARIESDr. M. Dhivya Lakshmi.Saveetha Dental College & Hospitals

DENTAL CARIES“ It is defined as a microbial disease of the calcified

tissues of the teeth characterized by the dimeneralization

of inorganic portion and dissolution of the organic portion

of the tooth.”

- Shafer, Hine & Levy

EPIDEMIOLOGYPRE NEOLITHIC AGE NEOLITHIC AGE

EPIDEMIOLOGYNEANDERTHAL PERIOD

ETIOLOGYWORM THEORY:

“Invasion of worms into teeth”

HUMORAL THEORY

VITAL THEORY

Originated like bone gangrene from within the tooth itself.

EXOGENOUS THEORIESCHEMICAL THEORY PARASITIC THEORY

ACIDOGENIC THEORY – MILLER (1890)

PROTEOLYSIS THEORY – GOTTILEB (1934)

PROTEOLYSIS CHELATION THEORY – SCHATZ & MARTIN (1955)

Products of bacterial action + enamel/ dentin/ salivary constituents chelates with calcium.

Chelates can be formed at neutral/ alkaline pH

Demineralization could arise without acid formation.

EPIDEMIOLOGICAL TRIAD

HOST

HOST

1. TOOTH

COMPOSITIONINORGANIC MATTER

ORGANIC MATTER & WATER

ENAMEL 96% 4%DENTINE 65% 35%CEMENTUM 45 to 50% 50 to 55%

MORPHOLOGY

2. SALIVA

3. GENDER & 4. RACE

5. AGE

6. DEVELOPMENTAL DISTURBANCES

7. ECONOMIC STATUS

8. FAMILIAL HEREDITY

9.CONCOMMITANT DISEASE

10. ORAL HYGIENE HABITS

MICROBES VS TOOTH Pre requisite Single type

capable Acid production –

pre requisite Strep strains

extracellular dextrans/ levans

Organisms – varying capacity

CARIOGENIC PLAQUE - PROPERTIES

Rate of sucrose consumption – higher

Synthesize more intracellular polysaccharides

More lactic acid Twice extra cellular

polysaccharides Strep mutans – higher Strep sanguis &

Actinomyces - lower

VIPEHOLM STUDY – GUSTAFFSON (1954)

STUDY DESIGN

CONTROL SUCROSE

BREAD

CARAMEL 8 TOFFEE

24 TOFFEECHOCOLATE

CONCLUSION

INCREASE IN CARB – INCREASE DC

RISK OF CARIES – GREATER – FOOD RETAINED ON THE SURFACE

RISK OF CARIES – GREATER – SUGAR CONSUMED BETWEEN MEALS

INDIVIDUAL VARIATION

RAPIDLY DISAPPEARS UPON WITHDRAWAL OF SUGAR RICH FOODS

HIGH CONCENTRATION OF SUGAR IN SOLUTION & PROLONGED RETENTION ON TOOTH SURFACES –

INCREASED ACTIVITY

PHYSICAL FORM & FREQUENCY OF INTAKE IS IMPORTANT

HOPEWOOD HOUSE STUDY – SULLIVAN (1958)

The dental status of children between 3 and 14 years of age residing at Hopewood House, New South Wales was studied longitudinally for 10 years.

DIET

INFERENCEPLACE % CARIES

ACTIVITYHopewood 53 Caries free

State School Children

0.4 Caries free75 Poor Oral hygiene

& gingivitis

“DENTAL CARIES CAN BE REDUCED BY DIET IN INSTITUTIONALIZED CHILDREN, WITHOUT BENEFICIAL

EFFECTS OF FLUORIDE & IN PRESENCE OF UNFAVOURAVLE ORAL HYGIENE.”

TURKU SUGAR STUDY – SCHEININ, MAKINEN (1975)

STUDY PERIOD = 2 years; n = 125

SUCROSE N = 35

FRUCTOSE

N = 38

XYLITOLN = 52

INFERENCE1. A dramatic reduction in the incidence

of dental caries was found after 2 years of xylitol consumption

2. Fructose was as cariogenic as sucrose for the first 12 months but became less so at the end of 24 months.

3. Chewing of xylitol gum produced an anti cariogenic effect.

SEVENTH DAY ADVENTIST CHILDREN STUDY

Limitation of sugar sticky elements, highly refined starches, between meal snacking.

Level of DC was much lower.

HEREDITARY FRUCTOSE INTOLERANCE

Level of DC – lower Vitamins A, D, K, B complex and calcium

& phosphorus, fluoride, amino acid like lysin & fats has an inhibitory effect on dental caries.

OTHERS GEOGRAPHY: DMFT increasing in developing

countries. SOIL: Selenium – increase DC; Molybdenum

& Vanadium – decrease DC URBANIZATION – DC increases. CLIMATE – Sunlight decrease DC; Rainfall –

increase DC.