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Dental caries, cause and preventive

strategies in children.

Dr. Nida Liaquat
MSPH 2009-10
Dental caries:
• Definition:
• It is a disease of microbial origin in which the dietary carbohydrates are
fermented by the bacteria forming an acid which causes the
demineralization of the inorganic part and disintegration of the organic part
of the tooth
Dental caries
• Dental caries is one of the most common of all disorders.

• It usually occurs in children and young adults but can affect any

• Plaque begins to build up on teeth within 20 minutes after eating.

• Dental plaque is a thin, tenacious microbial film that forms on the

tooth surfaces and has colonies of bacteria.
Dental Epidemiology
• From the Australopithecines (over a million years ago) to the Neolithic (since 10,000
years ago), carious lesions have been found in almost every population study.

• In 1942, Authorities like Robert Robertson and his co workers carried out major break
through was the relationship of dental caries and fluorides.

• Fluorides was an accidental discovery, which opened the doors of preventive dentistry.

• The evidence for trends in dental caries is especially interesting amongst North
American Indians.

• When sugars have been introduced into the diet, fissure and proximal surface cavities,
particularly in children, became dominant.
• An interplay of three
principal factors is
responsible for this
multifactorial disease.

• Thus, caries requires a

susceptible host, cariogenic
oral flora and a suitable
substrate, which must be
present for a sufficient length
of time
Role of saliva
Global perspective:
• There has been remarkable progress in the reduction of tooth decay
in the U.S. over the past 30 years. Nevertheless, dental caries
continues to be a significant problem for many children.

• More than half of all children in the U.S. have dental caries by the
second grade of school. By the age of 17, approximately 80% of
young people have had a dental cavity.

• Water fluoridation in New Zealand reduces the risk of dental caries.

• High risk children belong to low income families with poor parental
behaviors and attitudes.
DMFT index in Emro Region

Country Year DMFT

Afghanistan 1991 2.9*
Iran Islamic republic 2001 1.8
2003 1.15
Morocco 1991 2.3
1999 2.5
Pakistan 1979 2.1
1988 1.2
1991 1.25
1999 0.9
2003 1.38
Saudi Arabia 1995 1.7
2002 5.9***
* 7-12 years
*** 12-14 years
In Pakistan



6 1999
4 2003

12 15 34-44
Fluoride analysis of drinking water
(1999-2000) (WHO)
District Fluoride levels (ppm)

Karachi 0.1-0.14

Lahore 0.08-1.42

Rawal pindi 0.02-0.4

Multan 0.07-0.35

Peshawar 0.11-0.15

Quetta 0.86-1.11
Global policy for improvement of oral health
in the 21st century – implications to oral
health research WHO 2007.
• For the first time in 25 years oral health was subject to discussion.

• Advances in oral health science have not yet benefited the poor
and disadvantaged populations worldwide.

• The report provides a comprehensive analysis of the global burden

of oral disease.

• Effective use of fluoride.

• Action plan for promotion and integrated disease prevention.

• Oral health of children and youth through:

• Health Promoting Schools
• Healthy diet and nutrition
• It is important to increase the general awareness regarding oral health and
more particularly for the economically disadvantaged portion of the child

• At a present time there are very few programs aiming at increasing the
awareness regarding child’s oral health

• In dental offices there is little understanding if and in what capacity private

practitioners could be involved in the implementation of such programs.

• Therefore, it is important for every dental practice to assess if and in what

capacity they could be involved in reaching out to both the children and
their parents and guiding them toward improved child’s oral health.

To reduce the prevalence of dental caries in children of



• To measure the DMFT index of school going children between

6-12 years.
• To Assess their dietary habits.
• To provide the oral health education to children, and
1. Establishment of children dental club.

2. Raising awareness and capacity building.

3. Seminars will be organized on oral education for the

prevention of tooth decay.

4. Involvement of the policy makers regarding water


5. Multisectoral approach.
Children’s club has been specifically designed a
program, including a reward\motivation
system that benefits the child and a somewhat
of a counseling\guidance system that will
frequently remind and help the caregiver
maintain the child’s oral health.
Children Dental Club Model

• Forms will be distributed to the children’s parents who are coming to clinics.

• Dental club recall patients every after 6 weeks, health promotion material are provided to them related risk factors

• Parents are at the same time asked to answer two to three questions and mail them in the envelope provided.

• At the next recall visit if the child will present with healthy teeth he/she will earn the membership to “Dental Club”.
• The member child will be able to use this card to get Toys
from the dental clinic.

• Dental Club membership and the health promotion letters, that

are to be sent to the parents, are designed to increase the
awareness regarding oral health and to award and motivate
children and parents in achieving and maintaining oral health.

Dental club is a true investment in health and

it will be a unique model for Pakistan.
2. Raising Awareness and
Capacity building

• Conduction of Health Education sessions.

• Involving Mass media (TV, Radio, Dental pamphlets
and Newspapers)
• Display of oral hygiene promotional material in the
• Organize Dental camps in Schools.
• Those children who diagnosed decayed will refer to the
dental club.
• Training of Dental Professional regarding Promoting
oral hygiene.
• Seminars will be organized in schools for the provision of
oral health education among children. Parents will be
invited too and dental gifts (toothpaste and tooth brush)
will be distributed to the children.

• Documentary videos contain the oral health material will

be shown too.
Oral health education regarding
Caries prevention
1 2
Reduce the Increase the
pathogenic resistance of
potential of tooth
dental plaque structure to
caries attack
Plaque removal

• Tooth brushing
• Flossing
• Chemotherapeutic agents-
e.g. Chlorhexidine- short
term benefit
• Chewing gums- ADA
• Reduce sucrose consumption
• Sweets are not to be eaten between meals or at
• Emphasize foods that require chewing, stay away
from soft/sticky foods
• Brush teeth after meals and ALWAYS at Bedtime
• Discuss the danger of “hidden” sugars such as
starchy foods (bread)
Fluoride Therapy
• Systemic Fluorides
– Provided by water fluoridation.

• Water Fluoridation
– Concentration of 1 ppm of fluorides in drinking
water is considered optimal in reducing caries
– Optimal fluoride concentration reduces caries up
to 50%
Fluoride Therapy
• Topical Fluorides
– Delivered via gels, varnishes, mouth rinses and dentifrices.
– Commonly use topical fluorides sodium fluoride,
hydrofluosilic acid and sodium silicofluoride
– No need for topical fluoride in patients with low risk and/or
residing in optimally fluoridated areas- use of a fluoridated
toothpaste should be sufficient.
– Fluoridated dentifrices are not recommended in small
children (<3 years)
Toxicity by fluorides:
– Pea-sized amount.

– Dental fluorosis.

– Make sure child thoroughly

expectorates toothpaste after

– Administer milk to slow

Augment salivary factors

• Sugar free chewing gums.

• Supportive life styles.
• Stop eating betel nuts.
Oral hygiene Instructions:

Oral hygiene is necessary to prevent cavities. This consists of

regular professional cleaning (every 6 months), brushing at
least twice a day, and flossing at least daily. X-rays may be
taken yearly to detect possible cavity development in high risk
areas of the mouth.
4. Involvement of the policy makers:
• Ban/Restriction to the candy floss and toffees
in school canteen.

• Ban/Restriction on eating candies in classes.

• Provision of fluoridated water in schools

5. Multisectoral approach

• Health Department
• Education Deptt.
• Private schools
• NGOs
• Dental clinics
• Pharmaceuticals (Colgate, MacLean's etc.)
• No. of children include in dental club.
• No. of their parents/caregivers involved.
• No. of seminars conducted.
• No. of sessions conducted.
• No. of dental offices included.
• No. of schools included.
• No. of dental nurses hire/trained.
• DMFT Index
• No. of Dental Caries diagnosed
Dental diseases are largely preventable
and increased emphasis on prevention
should be the goal of every dental
“Knowing is not enough, we must apply.
Willing is not enough, we must do.”
- Johann Wolfgang von Goethe