3 - Aetiology of Dental caries: the impact of sugar on dental caries Flashcards Preview

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1

What is dental caries?

A bacterial disease of the calcified tissues of the teeth characterized by demineralization of the inorganic and destruction of the organic substance of the tooth

2

what are the key facts to remember about dental caries?

• Dynamic process
• Balance between demineralization and remineralisation
• pH < 5.5 favours demineralization
• pH > 5.5 favours remineralisation
• Dependent on an individuals saliva buffering power

3

what is the most common non-communicable disease in children?

dental caries

4

what are the factors in caries aetiology?

-host and teeth
-micro-organisms (normally strep mutans)
-substrate
-time

5

what are the potential ways to change caries susceptibility and risk in the host and teeth?

-increase salivary buffering capactiy
-add trace elements (F) -(change suseptiblity of the tooth )
-use protective coating

6

what are the potential ways to change caries susceptibility and risk in micro-organisms?

-Remove/reduce plaque bacteria (biolfim)
-(Vaccincation?)

7

what are the potential ways to change caries susceptibility and risk in substrates?

restrict free sugar intake

8

what are the potential ways to change caries susceptibility and risk in time?

1. Reduce time substrate in contact with tooth
2. Reduce time specific bacteria in contact with tooth

9

what is the one specific substrate of caries?

sugar

10

what type of disease is caries?

Sugar dependant infectious disease

11

Describe plaque bacteria metabolism of sugars.

-Glucose or sucrose
-rapid metabolism homofermentation (glucose +sucrose are rapidly metabolised)
-lots of acid mainly lactic
-low pH

12

what different types of studies are used to collect evidence for a relationship between diet and dental caries?

• Human Observational Studies
• Human Interventional Studies (Clinical Trials)
• Animal Experiments
• Plaque pH studies
• Enamel slab experiments
• Incubation studies

13

what is involved in epidemiology?

• Concerned with the study of populations
• Looking at groups of people, not individuals

14

What type pf groups are used in epidemiology?

Geogrpahy, where they live, ethnicity, all visit same clinic
person,

15

What are the levels of evidence in the pyramid from the bottom up?

-expert opinions
-cross-sectional studies and case studies
-uncontrolled longitudinal studies
-controlled longitudinal studies
-randomised controlled studies

16

when does dental caries rate change?

change following changes in availability of dietary sugar

17

what case studies prove dental caries rates change following changes in availability of dietary sugar?

• Populations that had reduced sugar availability during the 2nd world war show a reduction in caries
• Island of Tristan da Cuhna
(imported sugar 1940+)

18

In what people are low dental caries rates reported?

reported in people who have habitually low intake of dietary sugar

19

What case studies prove low dental caries rates are reported in people who have habitually low intake of dietary sugar?

• Children of dentists
• Hopewood House 1947-62
• Where strict dietary regimes
are followed

20

Describe the outcome of cross sectional studies in caries.

Numerous cross-sectional epidemiological studies from many countries have related sugar intake with dental caries levels at one point in time

21

what do prevalence studies do?

These look at the prevalence of the disease at
any one time

22

What is prevalence?

the percentage or proportion of people in a population who have a disease or condition at a given point in time

23

what do longitudinal studies show?

stronger evidence for a relationship between diet and dental caries by assessing sugar eating habits over time

24

Describe the 4 year prospective study of sugar sweetened beverages and dental caries in adults.

• Data from 939 patient analysed
• Compared those with reported ‘high sugar sweetened beverage consumption’ to those with low
• Found that drinking SBBs on a daily basis increased caries risk in adults even when tooth brushing with a fluoride toothpaste taken into account

25

what provides some of the strongest evidence for an association between diet and disease?

Human interventional studies

26

Give examples of human interventional studies.

• Vipeholm Study
(Gustaffson et al. 1954)
• Turku Sugar Studies
(Scheinin and Makinen 1975)

27

what is the reason for not carrying out human interventional studies?

ethical constraints

28

What is the evidence that sugar causes caries?

• Epidemiological data show link between sugar consumption and caries
• Caries prevalence higher in communities with high sugar intake
• Caries prevalence increases when sugar introduced to isolated communities
• Caries decreases when sugar restricted

29

Name 2 types of sugars from total sugars.

-extrinsic sugars
-intrinsic sugars

30

what can extrinsic studies be split into?

-milk sugars
-non-milk extrinsic sugars