2. OVERVIEW DEMOGRAPHIC “RISK FACTORS” BIOLOGIC& ENVIROMENTAL “RISK FACTORS “& “RISK INDICATORS” ROOT CARIES EARLY CHILDHOOD CARIES DESCRIPTION & HISTORY MEASUREMENT DIAGNOSING CRITERIA “CARIES FREE” DISTRIBUTION SECULAR VARIATIONS IN CARIES EXPRIENCE Dr.Toutouni
3. Description Dental caries is a mutifactorial disease that dissolve and destroy mineralized dental tissues. Dr.Toutouni MICROORGANISMS SUBSTRATE TIME HOST & TEETH
4. History ( Measurement): From early Twentieth century: 1- Proportion of lost molars through caries 2-The percentage of erupted permanent teeth affected by caries Problem: Lack of sensitivity Bodeckers’ index: decayed surfaces Problem: Complicated Forerunner of DMF index: Dean Dr.Toutouni
5. INDICES DISEASE DMF INDEX dmf def df SiC INDEX GRAINGER’S HIERARCHY HEALTH “CAREIS FREE” PERCENTAGE FS-T INDEX T-HEALTH INDEX Dr.Toutouni
6. DMF INDEX: Applied only to permanent teeth D Decayed, M Missing due to caries, F Filled DMF 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, Bridge pontics , Sealed teeth DMFST, DMFSS In large a survey: Half –mouth Dr.Toutouni
7. 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 extreme values Dr.Toutouni
8. SiC INDEX: Significant caries index Description: The mean of the extremevalues of DMF index( In one- third of the population) Dr.Toutouni
13. 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 numerical weight for a sound tooth, Filled tooth, Decayed tooth Dr.Toutouni
15. 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, undermined enamel, softened wall or temporary filling D4.Pulpal involvement: Deep cavity with probable pulpal involvement, pulp should not be probed. Dr.Toutouni
24. Criteria Pits and fissures are caries when: Opacity to the adjacent area providing evidence of undermining or demineralization. Softened enamel adjacent to the area that may be scraped by the explorer Visual method vs Visual- Tactile method A good proportion of noncavitated lesions remain static or even remineralize especially smooth surface lesions. Dr.Toutouni
25. caries New methods in diagnosing Fiberoptictransillumination Electrical conductance Laser fluorescence Advantages: Do not change the approach to measuring caries Detect non-cavitatedlesions at an early stages Dr.Toutouni
26. 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 Dr.Toutouni
27. Caries free Free of caries requiring restorative treatment Activities like early demineralization- remineralization cycles, white spots, stained fissure does not progress “ without obvious lesion” Dr.Toutouni
28. 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 of nineteenth century: Endemic disease Dr.Toutouni
29. DISTRIBUTION Most 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 Dr.Toutouni
32. SECULAR VARIATTIONS IN CARIES EXPERIENCE: More affected teeth were attacked within 2-4 years after eruption Early 1980s: The greatest reduction in caries prevalence As caries prevalence falls: The least susceptible sites(proximal & smooth surfaces) The greatest proportion The most susceptible sites( occlusal) The smallest proportion Dr.Toutouni
33. 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 Dr.Toutouni
34. DEMOGRAPHIC RISK FACTORS: Age In future: DMFT in all ages, M in adults, M & F in younger Dr.Toutouni
35. DEMOGRAPGIC RISK FACTORS: Gender: Higher DMFT score in women Reasons: Earlier eruption of teeth Treatment factor Race & Ethnicity:white race has higher F, lower D & M Higher DMFT in minorities Dr.Toutouni In the same age, D&M are equal in men & women, but higher F in women
36. :DEMOGRAPHIC RISK FACTORS Socioeconomic status: Social class is classified by: years of education, annual income, occupation, place of residence Reversely related to incidence of diseases In minorities: Higher SES Higher DMFT Familial & Genetic patterns : No transmission by Genetics Husband- wife similarities Mother to infant (window of infectivity) Just Form & Shape of the teeth Dr.Toutouni
37. BIOLOGICAL RISK FACTORS & RISK :INDICATOR Bacterial infection: No bacteria, No caries Caries: ecologic imbalance Diet Nutrition Dr.Toutouni
38. 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. Dr.Toutouni
39. ROOT CARIES: Importance in community dentistry: AGING Geriatrics is a new field in community dentistry Dr.Toutouni
40. RISK FACTORS : Loss of periodontal attachment Socioeconomic status Number of remaining teeth Use of dental services Oral hygiene levels Preventive behavior Multiple medication Radiotherapy Wearing partial denture Sucking candies in a dry mouth Living in an institution Higher coronal caries Gingival recession Low-Fluoride areas Smoking Race Xerostomia Dr.Toutouni
41. ROOT CARIES: Root Caries Index: (Root surfaces: decayed + filled)* 100 (Root surfaces with loss of periodontal attachment: decayed + filled + sound) Problems : It does not take into account thetime ,Sub gingival lesions. Dr.Toutouni
42. 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 treatment Dr.Toutouni
43. 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 Dr.Toutouni
