medical university of south carolina/sc-geriatric education center dental caries. determination....

Medical University of South Carolina/SC-Geriatric Education Center

Dental caries. Determination. Epidemiology of caries: prevalence and intensity of caries, increase of intensity. Card of epidemiology

examination of WHO. Etiology and cariogenesis. Modern pictures of reasons of origin and theory of development of caries: essence, advantages and failings. Concept of functionally structural

resistence of hard tissues of tooth. Lecturer: as. Yavors’ka-Skrabut I.M.Therapeutic dentistry department


The Epidemiology of Dental Caries in Older Adults


Overview Epidemiology

Epidemiology of dental caries Definition Distribution

By geography, age, gender, race/ethnicity, SES Determinants

Food cariogenicity, diet

Studies of dental caries in older adults

Conclusions


Learning Objectives

At the conclusion of this module, the participant will be able to: Define epidemiology Define dental caries Describe the dental caries index Describe the epidemiology of dental

caries Describe factors related to dental caries


Supplemental Documents

The Pre-Post Test Question with answers, References, and Evaluation Form for this module are found on a separate MS Word document.


Epidemiology1

Epidemiology is the study of the Distribution and Determinants of Disease/health in a population

Definition mnemonic – “3D’s”


Disease: Dental Caries2-4

How to define dental caries? Demineralization of the hard tissues of the

teeth caused by low pH, e.g., bacterial acids http://oralhealth.dent.umich.edu

/CDRAM/Principles.

How to measure dental caries? DMFT and DMFS http://

www.whocollab.od.mah.se/expl/orhdmft.html


Photo courtesy of DW Sneed, DMD, MAT

MUSC College of Dental Medicine

Human Teeth with Dental Caries

Dental enamel caries

Dental enamel demineralization


Photo courtesy of DW Sneed, DMD, MAT

MUSC College of Dental Medicine

Close-up Photograph of Root CariesDental enamel

Root

surface

Root caries


Disease: Dental Caries5-8

How to count dental caries for a population?U.S. National Surveys

NHANES, HHANES, NOHSShttp://www.cdc.gov/nchs/nhanes.htmhttp://www.cdc.gov/nohss/sealants/surveys.htm

NIDCR/CDC Dental, Oral, and Craniofacial Data Resource Centerhttp://drc.nidcr.nih.gov/default.htm


A Brief History of Dental Caries9

Evidence from human skulls 400’s – 1500’s

occlusal dental caries relatively uncommon attrition outpaced occlusal caries

root caries predominate

1600’s – 1800’s more refined foods, sugar new dental caries pattern

generally begin in pits & fissures of teeth later on proximal surfaces (between teeth) well-established by end of 1800’s in most developed

countries


Brief History of Dental Caries9

Throughout most of 1900’s Dental caries experience

seen primarily in high-income countries low prevalence in low-income world likely related to diet

Late 1900’s Dental caries experience

increase in some (not all) low-income countries decrease in high-income countries among

children young adults


Distribution: Dental Caries

Geographic Age

Gender

Race / ethnicity

Socioeconomic status

Familial patterns


Distribution: Geographic10

By Countryhttp://www.whocollab.od.mah.se/countriesalphab.html#TopVariation among countries


Distribution: Geographic

By Region in the US: Variation within country DMFS generally

highest in Northeast, lowest in West, and intermediate in Midwest and South

less distinct differences today than 50 years ago impact of fluorides and water fluoridation


Distribution: Age

DMF scores increase with increasing age DMF index is cumulative

(Decayed can become Filled, and then Missing through time)

Whole tooth missing due to dental caries is equal to a count of 4 or 5 surfaces in the DMFS index

Cohort effect


Average Number of Dental Caries on Permanent Teeth Surfaces (DMF), Among Dentate Persons by Age11

01020

30405060

708090

'18-19 '20-29 '30-39 '40-49 '50-59 '60-69 '70+

Age

Mea

n D

MF

S


Average Number of Root Caries Surfaces (Decayed or Filled) on Permanent Teeth Among Dentate Persons by Age11

0

0.5

1

1.5

2

2.5

3

'18-19 '20-29 '30-39 '40-49 '50-59 '60-69 '70+

Age

Ro

ot

Car

ies


Distribution: Gender

Females generally have higher DMF scores

Probable treatment effect females usually have higher “Filled”

component Earlier tooth eruption among females Cannot say females are more

susceptible to dental caries


Average Number of Coronal Caries on Permanent Teeth Surfaces, DMF, Among Dentate Persons by Gender and by Age11

0102030405060708090

'Mal

e

'Fem

ale

'Mal

e

'Fem

ale

'Mal

e

'Fem

ale

'Mal

e

'Fem

ale

'Mal

e

'Fem

ale

'Mal

e

'Fem

ale

'Mal

e

'Fem

ale

'18-19

'18-19

'20-29

'20-29

'30-39

'30-39

'40-49

'40-49

'50-59

'50-59

'60-69

'60-69

'70+ '70+

Mea

n D

MF

S

Age (years) by Gender


Distribution: Race-Ethnicity

Little evidence for inherent differences in dental caries susceptibility across race-ethnicity.

Differences in socioeconomic status associated with race-ethnicity in the U.S. are probably more important.


Distribution: Socioeconomic Status

SES relates to a person’s background-values Education Income Occupation

Most recent data suggest that DMFS scores are inversely related to SES


Socioeconomic Status and Age Groups

15-24 years 35-44 years 55-64 years

Average DMFS Scores for Adults in Three Socioeconomic Levels, 1988-949,11

0

1020

30

40

5060

70

80

Low Middle High Low Middle High Low Middle High

Average DMFS

DecayedMissingFilled

9,11


Percentage of adults aged 50 years and older with 21 or more teeth by race-ethnicity and federal poverty level10,11

• Age standardized to the year 2000 U.S. population.

4.2.3


Distribution : Familial Patterns9

“My family has bad teeth”

May be a function of Bacterial transmission Family habits/ culture

diet behavioral traits

Genetics (e.g., salivary flow, composition)

Additional research is needed


Determinants: Dental Caries

Host (teeth) Substrate (fermentable

carbohydrates) Flora (bacteria) Time


Determinants: Cariogenicity12

‘Cariogenicity’ is suggested to apply to gram-to-gram cariogenic potential for comparisons

‘Effective cariogenicity’ includes both the gram-to-gram cariogenic potential and the frequency and duration of exposure of the teeth

Fruits, in general, have very low or no cariogenic potential.


Determinants: Diet & Dental Caries9

The intake of refined carbohydrates, especially refined sugars, is a risk factor for caries,e.g., animal models human studies

Cooked or milled starches can be broken down by salivary amylase and then serve as a substrate for cariogenic bacteria

Uncooked / lightly cooked vegetables are considered virtually noncariogenic


Dental Caries Experience in Older Adults13

Four large cohort studies of adults aged 50 years or older Iowa North Carolina Ontario South Australia

Reports of coronal and root caries At least a 3 year follow-up period


Incidence and Increments of Coronal and Root Caries in Older Adults13

Number at follow-up

Observation period (years)

Coronal Caries Root Surface Caries Both Combined

Study Incidence Increment Incidence Increment Increment

Iowa 338 3 56% 2.4 (0.8)* 44% 1.1 (0.4) 3.5 (1.2)

North Carolina

3

Blacks 234 45% 1.6 (0.5) 29% 0.6 (0.2) 2.2 (0.7)

Whites 218 59% 2.1 (0.7) 39% 0.8 (0.3) 2.9 (1.0)

Ontario 493 3 57% 1.9 (0.6) 27% 0.6 (0.2) 2.5 (0.8)

South Australia

528 5 67% 2.7 (0.5) 59% 2.2 (0.4) 4.9 (1.0)

•Parentheses contain the annualized increment, computed by dividing the combined caries increment by the number of years of follow-up, then rounding the result to 1 decimal place


Risk Factors for Caries Development in Older Adults13

Coronal caries No common risk factors Suggested factors include low SES, and severity

of periodontal attachment loss at baseline

Root caries Common risk factor was partial denture wearing Other suggested factors include periodontal

problems and age


Caries in Swedish Older Adults14

Methods 10-year incidence study 55, 65, and 75 years old at baseline Measured coronal and root caries

Results Higher incidence of coronal caries in youngest

age group (65 years old at conclusion of study) Higher incidence of root caries in oldest age

group (85 years old at conclusion of study)


A State of Decay: The Oral Health of Older Americans15

September 2003: publication of an Oral Health America Special Grading Project

http://www.oralhealthamerica.org/pdf/StateofDecayFinal.pdf

Overall National Grade: D

Vast majority of older Americans do not have dental insurance coverage No Medicare dental coverage Most state Medicaid programs only cover emergency-only

dental benefits: D+ 71-80% do not have private dental insurance: D


Conclusions As the number of missing teeth increase with

increased age, so do the number of surfaces affected by dental caries

Older adults suffer from the accumulation of coronal and root caries over their lifetimes

Older adults have less dental insurance (Medicare does not cover usual dental services), make fewer dental visits, and use more medication that may lead to decreased saliva (xerostomia)


BiographySusan G. Reed, DDS, MPH, DrPH is an Assistant Professor of Stomatology, Director of the Dental Public Health & Oral Epidemiology Section at the College of Dental Medicine. Her joint appointment is with the Department of Biometry, Bioinformatics & Epidemiology. Her dental degree is from Case Western Reserve University and she is a 1996 graduate of the University of Michigan, School of Public Health where she completed her MPH, Residency in Dental Public Health, and was an NIH fellow for her doctorate in oral epidemiology. Dr. Reed is Board Certified in Dental Public Health. Her research interests include the epidemiology of oral cancer in SC, and oral Chlamydia trachomatis research.