EPIDEMIOLOGY OF DENTAL CARIES

Dr.Ghada Maghaireh BDS,MS,ABOD

Dental caries is an ancient disease, it has afflicted human at least from the time that agriculture replaced hunting.

Dietary changes during the 17th century principally increased refinement and greater use of sucrose are considered chiefly responsible for the development of modern pattern of dental caries.

Global Distribution

Dental caries used often to be referred to as the disease of civilization. This expression was used to describe the prevailing pattern of caries observed during most of the 20th century: high prevalence of the developed countries, low prevalence in the developing world.

Global Distribution

There are several interrelated reasons why this historical pattern developed. The most obvious reason is diet; the high level of consumption of refined carbohydrates in developed countries has long been synonymous with good life.

Poorer societies, however, survived on hunting and on subsistence farming, both of which provide diet, low in fermentable carbohydrates.
A related reason concerns the evolution of proliferation of cariogenic bacteria under the selective pressure of suitable diet.

Global Distribution

By the late 20th century, however, this traditional pattern was changing in two ways. First, there was evidence that the prevalence and intensity of dental caries in many developing countries were rising sharply. Second, change is an equivocal, marked reduction in caries experience among children and young adults in developed countries.

Global Distribution

But even in developed countries, there are distinct differences in caries experience from one country to another and from region to region within a country.

Decline in Dental Caries

The decline in dental caries was documented in countries with national studies on dental caries. The decline in dental caries was 32% between the first and second survey in the US (1971-1974 to 1979-1980).

Also 36% decline was detected between the second and third survey (1979-1980 to 1986-1987).
The decline has also been documented in primary teeth.

Decline in Dental Caries

Data from 9 different countries all appointed to the same conclusion, namely, that caries experience in children has declined considerably over generation or so.

An important aspect of caries decline is its effect on different tooth surfaces.

In US study 81% of all new carious lesions were on occlusal surfaces and pit and fissures of bucccal and lingual molar surfaces.

Causes of Caries Decline

Fluoride exposure

Decrease consumption of sugar

Better oral hygiene Changes in bacterial ecology of the oral cavity Wide spread use of antibiotics

Distribution of Caries Severity

DMF index is an index to measure the distribution of dental caries in a group of people, society, or nations. The phrase DMF is composed of D = decay, M = Missing of teeth due to caries, and F = filling of carious tooth.

Distribution of Caries Severity

There is no generally acceptable definition of severe caries. However, DMF value of 7 or more considered severe caries in children. In US children up to age 17, there were 27.3% of children have severe caries (DMF>=7) in 1979-1980 survey. This has dropped to 17% in the 1986-1987 survey.

In distributing the frequency of DMF among different type of people we will find that 50% of all affected teeth are found in about 12% of children, and over 75% of all affected teeth are in less than 25% of children.

Distribution of Caries Severity

This concentration of disease in relatively few children had led to the concept of targeting public health prevention programs toward that highly affected minority. And has stimulated research into methods of predicting which children are likely to be found in the 20% or so most affected.

Determinants and Risk Factors for Dental Caries

Age:

Mean DMF increases with age.

In the childhood there is high caries rate and in elderly there is high percentage of missing due to caries. However, new research demonstrated that carious attack is likely to spread out more through out life, and there is evidence that older adults can develop new carious lesions.

Determinants and Risk Factors for Dental Caries

Sex:

Females generally demonstrate higher DMF scores than do males, although this finding is not universal. The difference is small enough to be explained by earlier eruption of teeth in females, their teeth at risk in oral environment for longer time. Females visit the dentist more frequently, so treatment factor could be influencing the DMF data observed.

Probably a combination of earlier tooth eruption plus a treatment factor explains the observed differences in DMF values between males and females.

Determinants and Risk Factors for Dental Caries

Race and Ethnicity:

Contentions that certain races enjoy a high degree of resistance to dental caries have been around for a long time. These assertions have faded as the evidence mounts that global differences in caries experience are more a result of environment than they are of inherent racial attributes. The overall pattern that emerges from data from different studies is that there is no basis for believing in inherent difference between races and ethnicity. Socioeconomic differences, which means differences in education, self-care, attitude, values, available income, and access to health care, appear to be far more important determinant.

Determinants and Risk Factors for Dental Caries

Socioeconomic status:

Socioeconomic status (SES) is a broad measure of an individuals background in terms of such factors as education, income, occupation, attitudes and values. SES is a valuable measure in many health studies because it is also closely correlated with many health-related characteristics. In many studies differences in caries experience were found between children in the higher and lower social classes.

Determinants and Risk Factors for Dental Caries

Familial and genetic patterns:

Familial tendencies are seen by many dentists and have been demonstrated by research.
However, these studies do not pin down wither such tendencies have any genetic basis or weather they only represent bacterial transmission or continuing familial dietary or behavioral traits. Husband-wife similarities clearly have no genetic origin, and intrafamilial transmission of cariogenic bacteria has also been shown to occur.