Lecture 11: Childhood Caries

Question 1

Epidemiology

Answer 1

study of health and disease in populations

- distribution and determinants

Question 2

determinants are influenced by:

Answer 2

heredity
biology
physical environment
social environment
lifestyle

Question 3

Descriptive Study

Answer 3

studies prevalence, severity (morbidity/mortality), age-adjusted distribution in the population

Question 4

Analytic Study

Answer 4

Tries to answer a specific question

Question 5

Primary data

Answer 5

mail survey
epidemiological/screening survey
telephone interview

Question 6

Secondary Data

Answer 6

Medicaid
Vital Statistics
Cancer Registry

Question 7

Dental Caries

Answer 7

Demineralization of the hard tissues of the teeth caused by bacterial acids.

Question 8

_______ is one of the most common diseases among 5 to 17 year olds

Answer 8

dental caries

Question 9

Ancient Disease Caries

Answer 9

prehistoric man; low prevalence and severity

Question 10

5th-16th century dental caries

Answer 10

no change in prevalence between the AngloSaxon period to the Middle Ages in British Studies; mostly cervical lesions

Question 11

17th - 20th Century Caries

Answer 11

High prevalence of disease; mostly occlusal and proximal lesions associated with changes in diet circa 1600

Question 12

early 20th century caries

Answer 12

low prevalence in “developing”countries, high prevalence in developed” nations

Question 13

Late 20th Century Caries

Answer 13

• increasing prevalence in developing countries

- decrease in caries incidence in children and young adults in developed countries - the “caries decline”

Question 14

Worm Theory

Answer 14

Mesopotamia, 5000 BC

Caries caused by a worm, fumigation devices used to remove the worm.

Question 15

Vital Theory

Answer 15

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.

Question 16

Chemical (acid) theory

Answer 16

17th and 18th centuries
decay arises from acids formed in the oral cavity.
Assumed that acids were inorganic.

Question 17

Parasitic (specific) theory

Answer 17

Microorganisms infiltrate the enamel, leading to decomposition.
Recognition that enamel is organic.

Question 18

chemo-parasitic theory

Answer 18

(1881 W.D. Miller proposed):

microorganisms in the oral cavity cement carbohydrates and produce acids that can initiate demineralization.

Question 19

____ was associated with dental caries in 1914

Answer 19

Lead

Question 20

prior to WWII there were reports on the association between caries and:

Answer 20

poverty and race

Question 21

by 1960s, caries is known as:

Answer 21

multifactorial infectious disease

Question 22

necessary factors of caries

Answer 22

cariogenic bacteria and fermentable carbohydrates

Question 23

non-specific plaque hypothesis

Answer 23

total plaque microflora

Question 24

specific plaque hypothesis

Answer 24

only a few species involved

Question 25

ecological plaque hypothesis

Answer 25

shift in hemeostatic balance

Question 26

extended ecological plaque hypothesis

Answer 26

non-pathogenic bacteria can adapt to produce acid

Question 27

Caries definition:

Answer 27

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.

Question 28

Epidemiologic triangle (corners)

Answer 28

host, environment, agent

Question 29

Agent

Answer 29

microorganisms involved

Question 30

Microbes involved in caries

Answer 30

Streptococcus mutans - most cariogenic for enamel Streptococcus sobrinus Viellonella

Question 31

Mutans Streptococci (ms)

Answer 31

greater ms counts, greater caries prevalence

Question 32

MS are caries conductive because:

Answer 32

1. ability to adhere to tooth surface 2. produce copious amounts of acid 3. survive at low pH

Question 33

Environment

Answer 33

Fermentable carbohydrates

Question 34

Simple Sugars vs. Complex Sugars

Answer 34

Sucrose > glucose > lactose > fructose

Question 35

Vipeholm Study (1947)

Answer 35

- 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.

Question 36

Homewood House Study

Answer 36

(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%)

Question 37

Equation for etiology of dental caries

Answer 37

bacteria + CHO ---> acid ---> demineralization ---- caries

Question 38

Protective factors

Answer 38

- salivary flow and components - proteins, antibacterial components, and agents - fluoride, calcium, ad phosphate

Question 39

Pathological Factors

Answer 39

- Reduced salivary function - Bacteria: Mutans streptococci, and lactobacilli - Dietary Components: frequency and carbohydrates

Question 40

Determinants and Risk Factors

Answer 40

``` age gender race and ethnicity socioeconomic status geography ```

Question 41

Deterrence

Answer 41

``` saliva (antibacterial, antibodies to cariogenic bacteria, buffering) plaque removal -OH dietary habits fluoride therapy sealants caries vaccine antibiotics other ```

Question 42

how do we measure dental caries?

Answer 42

counts, proportions, rates, indices

Question 43

prevalence

Answer 43

number of people in a population who have a given disease at a given point in time.

Question 44

prevalence measures:

Answer 44

the frequency of all current cases of a disease (old and new)

Question 45

Incidence

Answer 45

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

Question 46

DMFT and DMFS

Answer 46

describe the amount - the prevalence - of dental caries in an individual - D -decayed - M -missing - F -filled - T -teeth OR - S -surfaces

Question 47

DMFS values of 7 or higher can be considered:

Answer 47

to indicate severe disease in children up to age 17 | *about 20% of US children

Question 48

Limitations of prevalence

Answer 48

- 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

Question 49

Prevalence =

Answer 49

D + M + F

Question 50

Untreated Caries =

Answer 50

D/DMF

Question 51

Treated Caries =

Answer 51

F/DMF

Question 52

Tooth Fatality =

Answer 52

M/DMF

Question 53

DMF index: limitations

Answer 53

``` invalid: perio, ortho, aesthetics, prevention root caries sealants teeth at risk DMFS vs DMFT ```

Question 54

deft (s) or dft (s)

Answer 54

``` d = decayed e = indic. extraction f = filled ``` *index is useful up to the age of 6, after which shedding becomes the dominant factor

Question 55

Significant Caries Index (SiC Index)

Answer 55

bring attention to the individuals with the highest caries values in each population under investigation

Question 56

SiC Index breakdown

Answer 56

- 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.

Question 57

SiC Example

Answer 57

45% are caries free. (DMFT =0), mean DMFT is 1.91, and the Sic index is 4.61

Question 58

poor children 2 to 9 in each racial/ethnic group have higher percentage of

Answer 58

untreated primary teeth than nonpoor children

Question 59

practical significance of the epidemiology of dental caries?

Answer 59

- planning, funding, and delivery of services. (ex. water fluoridation, clinics, medicaid) - training: numbers and type of professionals