epidemiology of oral diseases
TRANSCRIPT
EPIDEMIOLOGY OF ORAL DISEASESPRESENTED BY:Ramsha 946Namrah 947Zain 948
Epidemiology of ORAL CANCER Epidemilogy of MALOCCLUSION
Epidemiology of PERIODONTAL DISEASE Epidemiology of DENTAL CARIES
DEFINITION:It is defined as an indurated or ulcerated sore which may or may not be painful and is often associated with cervical lymph adenopathy
EPIDEMIOLOGY OF ORAL CANCER
EPIDEMIOLOGY1. GEOGRAPHIC VARIATIONS:In industrialized countries 3-5%In highly developing countries 40%2. SEX:More common in males
3. AGE:Usually occurs in 6th decade of life4. SITES OF ORAL CANCER:Lateral border of tongueLabial commissureBuccal mucosaUndersurface of tonge
HOST FACTORS1. AGE: older age shows increased risk of
CARCINOMAyounger age shows increased risk ok SARCOMA
2. RACE: lip melanoma in more common in whites whereas certain odontogenic tumors are more common in blacks
EPIDEMIOLOGICAL TRIAD
3. SEX: In females cancer of lip is commonIn males cancer of buccal mucosa and tongue is common4. GENETIC FACTORS: discovery of oncogenes made it possible
to identify the possible genetic and environmental factors associated with the initiation and progression on malignant tumors
5. OCCUPATION: male textile workers show increased risk of cancer of buccal cavity , larynx and pharynx.
6. IMMUNITY: kaposi sarcoma is more common in AIDS patient7. SOCIAL CLASS: low income groups show increase in cancer of
oral cavity8. CUSTOMS AND HABITS: tobacco chewing, pan chewing, spicy
food increases the rate of cancer of floor of mouth and buccal mucosa.
Alcohol consumption also increases the chance for cancer.
1. BIOLOGICAL: virus (HIV,HSV)Fungus (candida)2. CHEMICAL: arsenic, dyes, nickel,
aromatic amines, chromium3. MECHANICAL: sharp tooth, ill fitting
dentures
AGENT FACTORS
4. NUTRITIONAL: precarcinogens in food, increased consumption of fat, deficiency of folic acid, protein deficiency
1. WATER CONTAMINANTS: chloroform2. AIR POLLUTION: carbon dioxide3. GEOGRAPHIC VARIATIONS: in
Netherlands buccal mucosa is most commonly affected
In Switzerland lip, tongue are the sites most affected
ENVIRONMENTAL FACTORS
4. SOLAR HEAT: prolonged exposure to sunlight causes melanoma
5. INDUSTRIALIZATION: the release of various toxins by the industries contaminates water and air which may lead to cancer
SEQUELEA OF MALOCCLUSIONPoor facial appearanceRisk of cariesPredisposition to periodontal diseasePsychological disturbancesRisk of traumaAbnormalities of functionTMJ problems
EPIDEMIOLOGY OF MALOCCLUSION
EPIDEMIOLOGYPrevalence of malocclusion is estimated to be higher in
developed countries as compared to developing and under developed countries
Malocclusion percentage is relatively low in deciduous dentition.
Incidence of normal occlusion in deciduous dentition in 51%; mixed 40%; permanent dentition 30%
GRABERS CLASSIFICATIONGeneral factors:1. Heredity2. Congenital3. Environmental(a) pre-natal (trauma, maternal diet,
German measels, maternal metabolism)
ETIOLOGY
(b) Post natal ( birth injury, cerebral palsy, TMJ injury)4. Predisposing metabolic climate and disease1. Endocrine imbalance2. metabolic disturbances3. Infectious disease5. Abnormal pressure habits and functional aberrations4. Abnormal sucking
(b) Thumb and finger sucking(c) Tongue thrust and tongue sucking(d) Lip and nail biting(e) Improper deglutition(f) Speech defects(g) Respiratory abnormalities(h) Tonsils and adenoids1. Bruxism
7. Posture8. Trauma and accidentsLOCAL FACTORS1. anomalies of tooth number2. Amomalies of tooth size3. Anomalies of tooth shape4. Abnormal labial frenulum5. Premature loss
6. Prolonged retention7. Delayed eruption of permanent teeth8. Abnormal eruptive path9. Ankylosis10. Dental caries11. Improper dental restorations
PERIODONTAL DISEASE IS A TERM, WHICH INCLUDES ALL PATHOLOGICAL CONDITIONS OF PERIODONTIUM i.e: GINGIVA, ALVEOLAR BONE,CEMENTUM AND PERIODONTAL LIGAMENT.
EPIDEMIOLOGY OF PERIODONTAL DISEASE:
CHANGES IN THE PERCEPTIONS OF PERIODONTAL DISEASES:
IN 1961, WHO SAID THAT GINGIVITIS LEAD TO THE DEVELOPMENT OF PERIODONTITIS. ON THE CONTRARY RESEARCH BY 1990's SHOWED:
1. SEVERE PERIODONTITIS WAS SEEN ONLY IN A SMALL PROPORTION OF POPULATION, WHEREAS MILD & MILD TO MODERATE GINGIVITIS WAS MORE COMMON.
2. GINGIVITIS N PERIODONTITIS ARE ASSOCIATED WITH BACTERIAL FLORA WHICH MAY HAVE SIMILARITIES BUT MAY ALSO DIFFER. ONLY FRACTION OF SITES AND NOT ALL SITES WITH GINGIVITIS LATER DEVELOP PERIODONTITIS.
3. PERIODONTAL DISEASE IS NOT A NATURAL CONSEQUENCE OF AGEING.
SOME OF THE INDICES USED IN THE STUDY OF PERIODONTAL EPIDEMIOLOGY ARE;
1. PERIODONTAL INDEX2. PERIODONTAL DISEASE INDEX3. PAPILLARY-MARGINAL ATTACHMENT INDEX4. GINGIVAL INDEX5. OHI-S6. CPITN
EPIDEMIOLOGICAL INDICES:
• HOST FACTORS--1. AGE- CHRONIC DESTRUCTIV PERIODONTAL DISEASE HAS BEEN ASSOCIATED WITH
AGES GREATER THAN 40.2. SEX- MORE COMMON IN MALES.3. RACE- BLACKS ARE MORE AFFECTED.4. INTRA ORAL VARIATIONS- MORE SEEN IN INTERPROXIMAL AREAS THAN BUCCAL
OR LINGUAL AREAS.UPPER ARCH IS MORE PRONE TO GINGIVITIS AND IS MORE SEEN IN LEFT ARCH THAN ON THE RIGHT ARCH.
5. SEVERITY OF BONE LOSS- SEVERELY AFFECTED ARE THE LOWER CENTRALS AND THE LATERALS AND UPPER MOLARS.
6. ENDOCRINE CHANGES- PUBERTY, PREGNANCY, HYPERTHYROIDISM AND PARATHYROIDISM INCREASE CHANCES OF GINGIVITIS.
7. TRAUMATIC OCCLUSION- SHARP CUSP ACTS AS 'PLUNGERS' AND LEAD TO PERIODONTITIS.
8. FOOD IMPACTION
EPIDEMIOLOGICAL TRIAD:
9. TOOTH POSITION- IRREGULAR ALIGNMENT MAKES IT DIFFICULT TO KEEP THESE AREAS CLEAN.ROOTS MAY APPROACH CLOSE TO EACHOTHER WHICH MAY ALLOW INSUFFICIENT INTERVENING ALVEOLAR SUPPORT.
10. OCCUPATIONAL HABITS- THREAD BITING N HOLDING NAILS BETWEEN TEETH CAN PRODUCE TRAUMATIC AFFECTS ON PERIODONTIUM.
11. BRUXISM,LIP, CHEEK AND NAIL BITING CAN AFFECT ALSO.12. USE OF TOBACCO- IT LOWERS THE TISSUE RESISTENCE IN THE ORAL
CAVITY.13. MISUSE OF TOOTHBRUSH. 14. CONCOMITANT DISEASE- ALVEOLAR BONE DESTRUCTION AND GINGIVITIS
MAY BE ACCENTUATED IN Pts. WITH UNCONTOLLED DIABETES, HEAVY METAL POISONING, ACUTE MONOCYTIC LEUKEMIA AND PERNICIOUS ANEMIA.
15. INCOME AND EDUCATION
AGENT FACTORS;
1. PLAQUE, 2. CALCULUS1. DENTAL PLAQUE IS THE PRIMARY ETIOLOGIC FACTOR FOR
PERIODONTAL DISEASE. THEY ARE SOFT DEPOSITS FORMING A BIO-FILM ADHERENT TO THE TOOTH SURFACE AND ALSO INCLUDING REMOVABLE AND FIXED RESTORATIONS.
2. CALCULUS IS AN ADHERENT CALCIFIED MASS THAT FORMS ON THE SURFACE OF NATURAL TEETH AND DENTAL PROSTHESIS. IT CONSISTS OF MINERALIZED PLAQUE.
ENVIRONMENTAL FACTORS;
1. GEOGRAPHIC VARIATIONS- FOUND TO BE HIGH IN JORDAN,INDIA, MALAYSIA. FOUND TO BE INTERMEDIATE IN USA(BLACKS), COLUMBIA, ETHIOPIA AND ECUADOR AND LOW IN US whiteS AND PRIMITIVE ESKIMOS OF ALASKA.
2. NUTRITION- AVITAMINOSIS C, NIACIN DEFICIENCY AND VITAMIN A DEFICIENCY.
3. DEGREE OF URBANIZATION- RURAL POPULATION SEEMS TO SUFFER MORE THAN URBAN POPULATION.
4. STRESS- STRESS IS SAID TO PREDISPOSE TO ACUTE NECROTIZING ULCERATIVE GINGIVITIS AND OFTEN SEEN IN MILITARY GROUPS AND IN EXAM GOING STUDENTS.
What is Dental Caries?
Dental caries is a microbiological , reversible, infectious disease that results in dissolution and destruction of calcified tissues of the tooth.
ORIt is a microbial ,infectious disease which leads to demineralization of enamel and
dentin followed by disintegration of their organic materials.
ORIt is a dynamic process (multifactorial) of episodic demineralization and
demineralization occurring over time. If demineralization process predominates ,disintegration of mineral component will occur leading to cavity.
Etiology of Dental Caries
THEORIES:1.Legend of the worm.2.Endogenous theories. Humoral theory. Vital theory.3.Exogenous theories. Chemical(acid) theory. Parasitic (septic) theory. Miller’s chemicoparasitic theory. Proteolysis theory. Proteolysis chelation theory.
SUGARS (non-cariogenic) BACTERIA
•Bulk sweeteners 1. Sorbitol2. Mannitol
•Streptococcus mutans primarily responsible-transmitted placentally in the first 30 months.
• Intense sweeteners(cariogenic)1. Saccharin2. Aspartame
•Lactobacilli
Progression of Caries
FERMENTABLE SUGAR + PLAQUE BACTERIA
Organic acids dissolving tooth mineral
Main Etiological Factors
EPIDEMIOLOGICAL TRIAD.HOST ,AGENT ,ENVIRONMENT.
HOST FACTORS AGENT FACTORS ENVIRONMENTAL FACTORS
1) Host Factors:1. Tooth composition
and morphology2. Saliva(contents)3. Sex4. Race5. Age6. Familial heredity7. Developmental
disturbances8. Economic status9. Concomitant disease10. Oral hygiene habits
1. Role of micro-organisms : are pre-requisite for caries initiation, some produce extracellular dextrans or levans,may be acidogenic.
2. Properties of cariogenic plaque.
1. DietA. Vipeholm StudyB. Hopewood House
StudyC. Turku Sugar studyD. Seventh-Day Adventist
Children StudyE. Hereditary Fructose
Intolerance2. Geographic variations3. Soil4. Urbanization5. Climate
