Lecture 11: Childhood Caries Flashcards
Epidemiology
study of health and disease in populations
- distribution and determinants
determinants are influenced by:
heredity biology physical environment social environment lifestyle
Descriptive Study
studies prevalence, severity (morbidity/mortality), age-adjusted distribution in the population
Analytic Study
Tries to answer a specific question
Primary data
mail survey
epidemiological/screening survey
telephone interview
Secondary Data
Medicaid
Vital Statistics
Cancer Registry
Dental Caries
Demineralization of the hard tissues of the teeth caused by bacterial acids.
_______ is one of the most common diseases among 5 to 17 year olds
dental caries
Ancient Disease Caries
prehistoric man; low prevalence and severity
5th-16th century dental caries
no change in prevalence between the AngloSaxon period to the Middle Ages in British Studies; mostly cervical lesions
17th - 20th Century Caries
High prevalence of disease; mostly occlusal and proximal lesions associated with changes in diet circa 1600
early 20th century caries
low prevalence in “developing”countries, high prevalence in developed” nations
Late 20th Century Caries
- increasing prevalence in developing countries
- decrease in caries incidence in children and young adults in developed countries - the “caries decline”
Worm Theory
Mesopotamia, 5000 BC
Caries caused by a worm, fumigation devices used to remove the worm.
Vital Theory
Tooth is an integral part of the body, vitally affected by the body.
Disease processes take place from the “inside-out”
Tooth decay originates from within the tooth itself.
Chemical (acid) theory
17th and 18th centuries
decay arises from acids formed in the oral cavity.
Assumed that acids were inorganic.
Parasitic (specific) theory
Microorganisms infiltrate the enamel, leading to decomposition.
Recognition that enamel is organic.
chemo-parasitic theory
(1881 W.D. Miller proposed):
microorganisms in the oral cavity cement carbohydrates and produce acids that can initiate demineralization.
____ was associated with dental caries in 1914
Lead
prior to WWII there were reports on the association between caries and:
poverty and race
by 1960s, caries is known as:
multifactorial infectious disease
necessary factors of caries
cariogenic bacteria and fermentable carbohydrates
non-specific plaque hypothesis
total plaque microflora
specific plaque hypothesis
only a few species involved
ecological plaque hypothesis
shift in hemeostatic balance
extended ecological plaque hypothesis
non-pathogenic bacteria can adapt to produce acid
Caries definition:
an infections, communicable disease resulting in destruction of tooth structure by acid-forming bacteria found in dental plaque, an intraoral biofilm in the presence of sugar.
Epidemiologic triangle (corners)
host, environment, agent
Agent
microorganisms involved
Microbes involved in caries
Streptococcus mutans - most cariogenic for enamel
Streptococcus sobrinus
Viellonella
Mutans Streptococci (ms)
greater ms counts, greater caries prevalence
MS are caries conductive because:
- ability to adhere to tooth surface
- produce copious amounts of acid
- survive at low pH
Environment
Fermentable carbohydrates
Simple Sugars vs. Complex Sugars
Sucrose > glucose > lactose > fructose
Vipeholm Study (1947)
- incr. sugar intake - incr caries
- incr. risk if sugar was sticky form
- between meal ingestion of sugar was worse.
- variation among individuals.
- incr in caries disappeared when sticky candies withdrawn.
Homewood House Study
(in Australia in 1942)
- sucrose-restricted diet among 81 children aged 4 to 9 years.
- at the start of the study, 78% of the children were caries-free.
- 52% continued to be at age 13
- significantly higher that 13 year olds in general population (only 0.4%)
Equation for etiology of dental caries
bacteria + CHO —> acid —> demineralization —- caries
Protective factors
- salivary flow and components
- proteins, antibacterial components, and agents
- fluoride, calcium, ad phosphate
Pathological Factors
- Reduced salivary function
- Bacteria: Mutans streptococci, and lactobacilli
- Dietary Components: frequency and carbohydrates
Determinants and Risk Factors
age gender race and ethnicity socioeconomic status geography
Deterrence
saliva (antibacterial, antibodies to cariogenic bacteria, buffering) plaque removal -OH dietary habits fluoride therapy sealants caries vaccine antibiotics other
how do we measure dental caries?
counts, proportions, rates, indices
prevalence
number of people in a population who have a given disease at a given point in time.
prevalence measures:
the frequency of all current cases of a disease (old and new)
Incidence
a measure of the number of lesions/period of time
*limited in that they only measure the numbers of new initial lesions per unit of time
DMFT and DMFS
describe the amount - the prevalence - of dental caries in an individual
- D -decayed
- M -missing
- F -filled
- T -teeth OR - S -surfaces
DMFS values of 7 or higher can be considered:
to indicate severe disease in children up to age 17
*about 20% of US children
Limitations of prevalence
- provides past history only
- does not provide rate of lesion development
- does not indicate if caries is active or inactive
- does not provide the frequency of occurrence of new lesions
Prevalence =
D + M + F
Untreated Caries =
D/DMF
Treated Caries =
F/DMF
Tooth Fatality =
M/DMF
DMF index: limitations
invalid: perio, ortho, aesthetics, prevention root caries sealants teeth at risk DMFS vs DMFT
deft (s) or dft (s)
d = decayed e = indic. extraction f = filled
*index is useful up to the age of 6, after which shedding becomes the dominant factor
Significant Caries Index (SiC Index)
bring attention to the individuals with the highest caries values in each population under investigation
SiC Index breakdown
- individuals sorted according to their DMFT values
- one third of population with the highest caries scores is selected
- the mean DMFT for this subgroup is calculated. THIS VALUE IS THE SiC INDEX.
SiC Example
45% are caries free. (DMFT =0), mean DMFT is 1.91, and the Sic index is 4.61
poor children 2 to 9 in each racial/ethnic group have higher percentage of
untreated primary teeth than nonpoor children
practical significance of the epidemiology of dental caries?
- planning, funding, and delivery of services. (ex. water fluoridation, clinics, medicaid)
- training: numbers and type of professionals
