CARIOLOGY
LESSON #1
TOPIC: INTRODUCTION
INTRODUCTION TO ORAL EPIDEMIOLOGY
Dental Caries - An infectious microbiologic
disease of the teeth that results in the
localized dissolution of the calcified tissues
Oral health – Refers to the entire mouth
not just the teeth. It includes the gums, the
hard and soft palate, the lining of the
mouth and the throat, the tongue, lips,
salivary glands, chewing muscles and the
upper and lower jaws.
WHO – A state of complete physical, mental
and social wellbeing, not merely the
absence of tooth decay, oral and throat
cancers, gum disease, chronic pain, oral
tissue lesions, birth defects and other
diseases and disorders that affect the oral,
dental and craniofacial tissue.
ORAL HEALTH
- Oral health is an essential and
integral component of overall health
- Oral diseases impact on general
health and systemic diseases show
symptoms in the oral structures
- Dental caries and periodontal
disease affect virtually every human
being during their lifetime, although
both diseases are almost entirely
preventable.
What is the practical significance of the
epidemiology of Dental Caries? As a future
dentist practitioner why should this
interest me? Serves as a basis for
improvement like delivery of service in
equipment, materials
What is the value of a dental index? A
recording of what we see in the mouth.
Dental caries is a growing dental problem
and it has consequences 92.4% (2006 data)
of Filipinos has dental caries. Mostly are
remained untreated.
Oral Epidemiology in Clinical Practice
- Gives particulars on diseases of the
oral cavity
- Recognizes populations at risk of
oral disease or in need of specific
care.
- Compare regional, environmental,
social, and access similarities and
differences in dental care between
populations.
- Tests preventive interventions for
controlling diseases.
- Evaluates the effectiveness and
quality of interventions and oral
health programs.
Keywords/definitions
- Incidence: the number of new cases
of a disease or condition over a
given time period.
- Index: A standard numerical
measure of a disease or condition. It
extends from the proportion of the
individuals with a disease or
condition to the number of
millimeter of probing depth around
a tooth.
- Prevalence: The proportion (%) of
individuals exhibiting the disease or
condition in a defined population
group.
- Trends: The changes or differences
in the prevalence or incidence of
disease.
 Type of measurement scales for indices
o Nominal – name conditions
o Ordinal – lists conditions
o Interval/Ratio – establishes a
mathematical relationship
o Irreversible – measure
conditions that cannot be
reversed
o Reversible – measures
conditions that can be reversed
What makes a good index?
o Valid: measures to what it intends
to
Ex: to all cancer patients
o Reliable: reproducible and
repeatable
o Clear, simple and objective –
unambiguous criteria
Ex: Ovulation to female
o Quantifiable – data can be
numerically analyzed
Ex: be able to compute for it.
o Sensitive – can identify small but
significant changes
o Acceptable – to both patient and
clinician
DMF Index
- Almost 80 years used and a well-
established key measure of caries
experience
- (D) = total number of teeth or
surfaces that are decayed
- (M) = total number if teeth or
surfaces that are missing
- (F) = total number of teeth or
surfaces that are filled
- DMFT – pertaining to permanent
teeth, scores can range from 0-32
- DMFS – Pertaining to surfaces of
permanent teeth, scores can range
from 0-148
- dmft – pertaining to primary teeth,
scores can range from 0-2-
- dmfs – pertaining to surfaces of
primary teeth, scores can range
from 0-88
Note: capitalized = adults small letters =
kids
Calculating DMFT
Decayed – when a carious lesion(s) and/or
restoration are present, the tooth is
recorded as a D.
Missing – when a tooth has been extracted
due to caries it is recorded as an M
Filled – when a permanent or temporary
filling is present, or when a filling is
defective but not decayed this is counted as
an F.
Teeth that are not counted:
- unerupted teeth
- congenitally missing teeth
- supernumerary teeth
- teeth removed for reasons other
than dental caries
- primary teeth retained in the
permanent dentition
Calculating DMFS
- There are 5 surfaces on the
posterior teeth: facial, lingual,
mesial, distal, and occlusal.
- There are 4 surfaces on anterior
teeth: facial, lingual, mesial, and
distal.
• When a carious lesion or both a
carious lesion and a restoration are
present, the surface is listed as a D
• When a tooth has been extracted
due to caries it is listed as an M
• When a permanent filling is present
or when a filling is defective but not
decayed, this surface is counted as
an F.
• Surfaces restored for reasons other
than caries are not counted as an F.
• The total count is 128 or 148
surfaces.
Calculating dmft and dmfs
- For dmft, the teeth not counted are
unerupted and congenitally missing
teeth, and supernumerary teeth.
- The rules for recording d, m, and f
are the same as for DMFT
- As with DMFS, there are 5 surfaces
on the posterior teeth and 4
surfaces on the anterior teeth. The
total count surfaces is 88 surfaces.
Limitations of DMF Index
1. A significant amount of
interobserver bias and variability
2. They values do not provide any
indications as to the number of
teeth at risk or data that is useful in
estimating treatment needs.
3. That the indices give equal weight to
missing untreated decay, or well-
restored teeth.
4. That the indices do not account for
teeth lost for reasons other than
decay (such as periodontal disease)
5. That they do not account for sealed
teeth since sealants and other
cosmetic restorations.
NHANES Survey (US)
• National health and nutrition
examination survey is a series of
surveys conducted in the United
States beginning in the 1960s to
examine the oral and nutritional
status of a large, representative
population.
• The information collected focused:
- Caries
- Dental history
- Tooth retention
- Edentulism (tooth loss)
- Periodontal status
- Prosthodontic status
• Oral health has improved since the
1980s in the US
• Link between children’s of scores
and poverty
• The highest d and f scores were in
children living under the federal
poverty line (FPL)
• Difference in DMFT and DMFS
scores between the genders:
• Women demonstrate higher scores
compared to men of the same age:
It is most likely due to the fact that
women seek dental care more
frequently than men, and women
experience earlier tooth eruption
patterns.
• Men having more tooth caries
(15.8%) than women (12.7%)
NMEDS Survey (PH)
- According to 1998 National
monitoring epidemiological dental
survey, about 92.4% of Filipino
dental caries and 78% have gum
diseases (periodontal diseases)
- The dental caries experience of 12
year old Filipinos in terms of the
average number of decayed,
missing, and filled teeth (DMFT) is
4.48. This is high compared to WHO
standards of 3 DMFT and below for a
12 year old individual.
 NOHS Survey (PH)
- The 2006 national oral health
survey
- 97.1% 6 year old children suffer
from tooth decay. Four out of every
five children of this subgroup
manifested symptoms of
dentinogenic infection.
- 78.4% of 12 year old children suffer
from dental caries and 49.7% of the
same age group manifested
symptoms of dentinogenic
infections
- The severity of dental caries 8.4%
dmft the 6 year old age group 2.9
DMFT for the 12 year old age group.
- Filipinos bear the burden of gum
diseases early in their childhood:
74% of 12 year old children suffer
from gingivitis.
- If not treated early, these children
become susceptible to irreversible
periodontal disease as they enter
adolescence and approach
adulthood.