epidemiology of dental caries
TRANSCRIPT
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.