EPIDEMIOLOGY

OF DENTAL
CARIES
Dr. M. Dhivya Lakshmi.
Saveetha Dental College & Hospitals
 DENTAL CARIES
“ It is defined as a microbial disease of the calcified tissues

of the teeth characterized by the dimeneralization of

inorganic portion and dissolution of the organic portion of

the tooth.”

- Shafer, Hine & Levy

 EPIDEMIOLOGY
PRE NEOLITHIC AGE NEOLITHIC AGE
EPIDEMIOLOGY
NEANDERTHAL
PERIOD
ETIOLOGY
WORM THEORY:

“Invasion of worms into

teeth”
HUMORAL THEORY
VITAL THEORY

 Originated like bone

gangrene from within
the tooth itself.
 EXOGENOUS THEORIES
CHEMICAL THEORY PARASITIC THEORY
ACIDOGENIC THEORY –
MILLER (1890)
PROTEOLYSIS THEORY –
GOTTILEB (1934)
 PROTEOLYSIS CHELATION
THEORY – SCHATZ & MARTIN
(1955)

 Products of bacterial action + enamel/ dentin/

salivary constituents  chelates with calcium.
 Chelates can be formed at neutral/ alkaline
pH
 Demineralization could arise without acid
formation.
EPIDEMIOLOGICAL TRIAD
HOST
 1. TOOTH

COMPOSITION
INORGANIC ORGANIC
MATTER MATTER &
WATER
ENAMEL 96% 4%
DENTINE 65% 35%
CEMENTUM 45 to 50% 50 to 55%
MORPHOLOGY
2. SALIVA
3. GENDER & 4. RACE
5. AGE
6. DEVELOPMENTAL
DISTURBANCES
7. ECONOMIC STATUS
8. FAMILIAL HEREDITY
9.CONCOMMITANT
DISEASE
10. ORAL HYGIENE HABITS
MICROBES VS TOOTH
 Pre requisite
 Single type 
capable
 Acid production – pre
requisite
 Strep strains 
extracellular
dextrans/ levans
 Organisms – varying
capacity
CARIOGENIC PLAQUE -
PROPERTIES
 Rate of sucrose
consumption – higher
 Synthesize more
intracellular
polysaccharides
 More lactic acid
 Twice extra cellular
polysaccharides
 Strep mutans – higher
 Strep sanguis &
Actinomyces - lower
VIPEHOLM STUDY –
GUSTAFFSON (1954)
 STUDY DESIGN

CONTROL SUCROS BREAD

E
CARAMEL 8
TOFFEE

24 TOFFEE
CHOCOLATE
 CONCLUSION

INCREASE IN CARB – INCREASE DC

RISK OF CARIES – GREATER – FOOD RETAINED
ON THE SURFACE
RISK OF CARIES – GREATER – SUGAR
CONSUMED BETWEEN MEALS
INDIVIDUAL VARIATION
RAPIDLY DISAPPEARS UPON WITHDRAWAL
OF SUGAR RICH FOODS
HIGH CONCENTRATION OF SUGAR IN SOLUTION &
PROLONGED RETENTION ON TOOTH SURFACES –
INCREASED ACTIVITY
PHYSICAL FORM & FREQUENCY OF INTAKE IS
IMPORTANT
HOPEWOOD HOUSE STUDY –
SULLIVAN (1958)

 The dental status of children between 3 and

14 years of age residing at Hopewood House,
New South Wales was studied longitudinally
for 10 years.
DIET
 INFERENCE
PLACE % CARIES ACTIVITY
Hopewood 53 Caries free
State School 0.4 Caries free
Children 75 Poor Oral hygiene &
gingivitis

“DENTAL CARIES CAN BE REDUCED BY DIET IN

INSTITUTIONALIZED CHILDREN, WITHOUT BENEFICIAL
EFFECTS OF FLUORIDE & IN PRESENCE OF UNFAVOURAVLE
ORAL HYGIENE.”
 TURKU SUGAR STUDY –
SCHEININ, MAKINEN (1975)
 STUDY PERIOD = 2 years; n = 125

SUCROSE FRUCTOS XYLITOL

N = 35 E N = 52
N = 38
 INFERENCE
1. A dramatic reduction in the incidence of
dental caries was found after 2 years of
xylitol consumption
2. Fructose was as cariogenic as sucrose for
the first 12 months but became less so at the
end of 24 months.
3. Chewing of xylitol gum produced an anti
cariogenic effect.
SEVENTH DAY ADVENTIST
CHILDREN STUDY
 Limitation of sugar
sticky elements,
highly refined
starches, between
meal snacking.
 Level of DC was
much lower.
 HEREDITARY FRUCTOSE
INTOLERANCE
 Level of DC – lower
 Vitamins A, D, K, B complex and calcium &
phosphorus, fluoride, amino acid like lysin &
fats has an inhibitory effect on dental caries.
 OTHERS
 GEOGRAPHY: DMFT increasing in developing
countries.
 SOIL: Selenium – increase DC; Molybdenum &
Vanadium – decrease DC
 URBANIZATION – DC increases.
 CLIMATE – Sunlight decrease DC; Rainfall –
increase DC.