Epidemiology Of Dental

Caries
 Epidemiology
 The branch of medicine which deals with
the incidence, distribution, and possible
control of diseases and other factors
relating to health.
 Dental Caries
 Dental caries is an ancient disease;
evidence shows that, it has troubled
humans from the time that agriculture
replaced hunting as the principal source of
food.
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ul
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nci e
o f a
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•Ex
a t :
th
Low Caries incidence existed in
Ancient Man
 Low caries incidence in the ancient
man is due to diet which was :

 Comparatively low in
carbohydrates.
 Natural (unrefined)
diet.
 Coarse & not fully
prepared or cooked.
 Pattern Of Ancient Dental Caries
• The pattern of ancient caries was mostly
cervical or root caries
• coronal caries was relatively uncommon.
• Coronal caries seemed to start in the
occlusal fissures but developed no further
because the rate of attrition was faster
than the rate of progression.
 Pattern Of Ancient Dental Caries
cont.
 The ancient pattern of dental caries was
replaced in the 17th century by a new
pattern where a lesion begins in fissured
surfaces and develops later on proximal
surfaces.

• This pattern took place in the industrialized

countries as a result of the increased use of
sucrose as sugars became more available.
Global distribution during 20th
century
During most of the 20th
century, dental caries
pattern was :
I. High prevalence in
developed countries & higher
socioeconomic group.
II. Low prevalence in
developing countries with
less economic development.
Caries was referred to as
“a disease of civilization.”
 Global Distribution
 The most obvious reason for this historical pattern
is diet;

 The high level of consumption of refined

carbohydrates in developed countries in contrast
to diets low in fermentable carbohydrates in
developing countries
By the late 20th century, caries pattern was
changing in two ways:

1- Sharp rising in caries prevalence

and severity in most developing
countries especially urban areas.

2- Marked reduction in developed

countries.
 In both developed and
developing countries , there
are distinct variations in
caries experience from one
country to another and from
region to another within
The same Country.
The decline of caries in developed
countries is attributed to:
 Use of fluoridated tooth paste.
 Fluoridation of water supplies.
 The use of fissure sealants.
 Implementation of preventive programs
 better access to health care
 better living conditions.
 Change of sugar consumption, although the
change is not substantial.
 Global Distribution
cont.
upward trend of caries in many
developing countries is related to:
 The absence of widespread caries
preventive strategy.

 Increasing consumption of sugar containing

products.
Variation of caries within the mouth:

 The distribution pattern of

dental caries closely follows
that of plaque. Thus, the sites
in the mouth which are most
prone to caries are those
where plaque accumulates.
These sites are:
1. The fissures in the
occlusal surfaces of
molars.

2. The proximal areas.

3. The marginal area

between the tooth
and the gingiva.
Susceptibility of different teeth

Dental caries in the

human mouth is
usually distributed in
a bilateral symmetry.
Susceptibility Of Different Teeth
 According to the Hagerstown
studies (1937), the rank order of
susceptibility of teeth to caries
was listed as follows:
1
Mandibular 1st & 2nd molars

2 Max. 1st & 2nd molars

Mand. 2nd,max. 1st & 2nd premolars

3
max. central & lateral incisors.

Max. canines & mand.

4
1st premolars

Mand. Central& lateral

5
Incisors & canines.
 Dental Caries
 It is the disease of calcified tissues.
 It is a multifactorial disease in which the
following risk factors play role in its
causation process:
1. Agent: Microorganisms
2. Host: Personal and tooth risk factors.
3. Environment: Dietary, and oral hygiene
related risk factors.
 Host
Environmental
Agent
1- Age.
2- Gender. 1-Flouride.
3- Race. 2-diet. 1-Streptococcus
4- Genetic mutans.
3-Social factors.
&familial. 2- Lactobacilli.
5- Nutrition 3- Actinomyces.
 Microbial agent

 Dentalcaries is a bacterial
disease.

 Regardless of any other factor,

caries does not occur in the
absence of bacteria.
 Agent Factors of Dental Caries
Microorganisms
 Mainly Streptococcus mutans are responsible
for initial development of dental caries with
contribution of other species such as:
 Lactobacillus acidophilus
 Lactobacillus casei
 Streptococcus salivarius
 Strpetococcus milleri
 Streptococcus sanguis
 Actinomycis (root caries)
 The host Risk Factors

 1- Age.
 2- Gender.
 3- Race.
 4- Genetic & familial.
 5- Nutrition
 Age
Caries was considered a
childhood disease
because all susceptible
tooth surfaces become
carious during early
child years and few
carious lesions are
affected during
adulthood.
 Age
• In communities with
lower attack rate,
young people reach
adulthood with most
surfaces caries free
and caries attack
spread out more
throughout life.
 Age
 Caries increases progressively by
age, and the increase is more
slowly during adult years
 This is due to:
 Most of the susceptible surfaces
are likely to have been attacked
by that time.
 After age of 60 years,
caries increases again
because of root caries.
Gender
 It is observed
that caries
prevalence is
higher in females
than in males of
the same age.
Females generally demonstrate higher
DMF scores than males probably due to :
• The earlier tooth eruption in females; their
teeth are at risk for a longer time.
• Females visit the dental clinics more
frequently (treatment factor).
The impact of these determinant, however
has not been well quantified.
 Race
 Early studies, observed that
some races as those in Africa &
India, had high degree of caries
resistance than “Europeans”.
 Recently, the concept of racial
differences have been faded, and
the evidence reveals that the
global differences are the result
of environment. .
 Race
 This was supported by the fact that these
racial groups, once thought to be resistant
to caries (Africans and Indians), quickly
developed the disease when they moved
to areas with different cultural and dietary
patterns.
 The variation in caries prevalence is the
result of environmental rather than they
are of racial attributes.
 Familial & genetic pattern
 Dental caries has long
ago shown to be
grouped according to
families.

 Members of the same

household were found
to be alike in their
caries pattern than
between unrelated
groups of individuals.
Such familial tendency may be due to:

1- Interfamilial bacterial transmission,

especially from mother to baby.
2- similarity in dietary & oral hygiene
habits. OR,
3- Genetic factor: as inheritance of
tooth structure (deep narrow pits &
fissures) or special arch form
(irregularities & crowding).
 Socioeconomic status
• It is a measure of the individual’
background; education, income,
occupation, and attitudes and values.

• It is inversely related to the status of

many disease.

• It is a powerful determinant of caries

status in any community.
 Socioeconomic status
 Earlier studies found that higher SES
groups had higher DMF scores than those
in the lower SES groups.

 Details of DMF scores showed that lower

SES groups had higher values for D and M,
lower for F.

 Whereas, the increased number of filled

teeth (F) raised the DMF index among the
high SES groups “treatment factor”.
 The difference between social
groups is due to increased
number of filled teeth (F) that
raised the whole DMF index
among high SES groups
“treatment factor”.
 Socioeconomic Status (SES):
 With the reported caries decline, the
DMF values of the higher SES groups
became considerably below those in
the lower SES group.
 The inverse relationship between
caries status and SES have been
reported from the developed
countries
 The opposite have been reported in
Africa
 Nutrition and Dental Caries
 There is some evidence that chronic
malnourishment during development periods
in a poor society may predispose to caries.

 No relation between nutritional adequacy

and DMF scores could be find.

 Vitamin D deficiency may cause enamel

hypoplasia.
 Prior to modern preventive
methods :
 Caries prevalence was low in countries with
low living standards, where generalized
malnutrition was the norm.

 Current epidemiological evidence favors the

conclusion that nutritional status does not
directly influence the prevalence of dental
caries (except for fluoride).
 Environmental Risk Factors
of Dental Caries
Diet :
• Diet refers to the total intake of
substances that provide nourishment and
energy.
 Diet
 Intake of refined carbohydrates
especially sucrose (sugar) is
considered a strong etiologic factor
in the causation of dental caries.
 Diet and Dental Caries
 Cariogenicity of the diet : Sugars and
fermentable carbohydrates are a major
etiological factor in the causation of caries.

 Cleansing nature of the diet : Accumulation

of fermentable carbohydrates could be
removed by eating hard and fibrous foods
(detersive food).

 Salivary stimulation effect of the diet : Food

that induce salivary flow keeps the mouth
free of fermentation.
 Sugar-Caries Relationship
The role of sugar in dental caries is related to:
1. Frequency of consumption of sugars; the risk
increased if sugars are taken between meals.
2. The frequency of consumption is of major
importance.
3. The nature of sugars; the risk is greatest if
the sugar is in sticky form.
Environmental Risk Factors of Dental
Caries
Oral hygiene practices
 Poor level of personal oral hygiene
maintained by the individual is considered
an important environmental risk factor for
dental caries.
 Healthy oral hygiene practices include
thorough daily removal of dental plaque
and other debris by toothbrushing,
flossing and mouth rinsing.
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