4dental caries. determination. epidemiology

8/12/2019 4Dental Caries. Determination. Epidemiology

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Medical University of South Carolina/SC-Geriatric Education Center

Dental caries. Determination. Epidemiology of

caries: prevalence and intensity of caries,increase of intensity. Card of epidemiology

examination of WHO. Etiology and cariogenesis.Modern pictures of reasons of origin and theory

of development of caries: essence, advantagesand failings. Concept of functionally structural

resistence of hard tissues of tooth.Lecturer: as. Yavorska-Skrabut I.M.Therapeutic dentistry department


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The Epidemiology ofDental Caries in

Older Adults


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Overview Epidemiology

Epidemiology of dental caries

Definition

Distribution By geography, age, gender, race/ethnicity, SES

Determinants

Food cariogenicity, diet

Studies of dental caries in older adults

Conclusions


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Learning Objectives

At the conclusion of this module, theparticipant will be able to:

Define epidemiology

Define dental caries

Describe the dental caries index

Describe the epidemiology of dental

caries Describe factors related to dental caries


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Supplemental Documents

The Pre-Post Test Question withanswers, References, and EvaluationForm for this module are found on aseparate MS Word document.


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Epidemiology1

Epidemiology is the study of the

Distribution and

Determinants of

Disease/health in a population

Definition mnemonic 3Ds


7/35Medical University of South Carolina/SC-Geriatric Education Center

Disease: Dental Caries2-4

How to define dental caries? Demineralization of the hard tissues of the

teeth caused by low pH, e.g., bacterial acids

http://oralhealth.dent.umich.edu/CDRAM/Principles.

How to measure dental caries?

DMFT and DMFS

http://www.whocollab.od.mah.se/expl/orhdmft.html
http://oralhealth.dent.umich.edu/CDRAM/Principles.htmhttp://oralhealth.dent.umich.edu/CDRAM/Principles.htmhttp://www.whocollab.od.mah.se/expl/orhdmft.htmlhttp://www.whocollab.od.mah.se/expl/orhdmft.htmlhttp://www.whocollab.od.mah.se/expl/orhdmft.htmlhttp://www.whocollab.od.mah.se/expl/orhdmft.htmlhttp://oralhealth.dent.umich.edu/CDRAM/Principles.htmhttp://oralhealth.dent.umich.edu/CDRAM/Principles.htm



Photo courtesy of DW Sneed, DMD, MAT

MUSC College of Dental Medicine

Human Teeth with Dental Caries

Dental enamel caries

Dental enamel demineralization



Photo courtesy of DW Sneed, DMD, MAT

MUSC College of Dental Medicine

Close-up Photograph of Root CariesDental enamel

Root

surface

Root caries



Disease: Dental Caries5-8

How to count dental caries for apopulation?

U.S. National Surveys

NHANES, HHANES, NOHSShttp://www.cdc.gov/nchs/nhanes.htm

http://www.cdc.gov/nohss/sealants/surveys.htm

NIDCR/CDC Dental, Oral, and Craniofacial DataResource Center

http://drc.nidcr.nih.gov/default.htm
http://www.cdc.gov/nchs/nhanes.htmhttp://www.cdc.gov/nohss/sealants/surveys.htmhttp://drc.nidcr.nih.gov/default.htmhttp://drc.nidcr.nih.gov/default.htmhttp://www.cdc.gov/nohss/sealants/surveys.htmhttp://www.cdc.gov/nchs/nhanes.htm



A Brief History of Dental Caries9

Evidence from human skulls

400s 1500s occlusal dental caries relatively uncommon attrition outpaced occlusal caries

root caries predominate

1600s 1800s more refined foods, sugar

new dental caries pattern generally begin in pits & fissures of teeth

later on proximal surfaces (between teeth)

well-established by end of 1800s in most developedcountries



Brief History of Dental Caries9

Throughout most of 1900s Dental caries experience

seen primarily in high-income countries

low prevalence in low-income world

likely related to diet

Late 1900s

Dental caries experience increase in some (not all) low-income countries

decrease in high-income countries among

children

young adults


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Distribution: DentalCaries

Geographic

Age

Gender

Race / ethnicity

Socioeconomic status

Familial patterns


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Distribution: Geographic10

By Countryhttp://www.whocollab.od.mah.se/countriesalphab.html#Top

Variation among countries
http://www.whocollab.od.mah.se/countriesalphab.htmlhttp://www.whocollab.od.mah.se/countriesalphab.htmlhttp://www.whocollab.od.mah.se/countriesalphab.htmlhttp://www.whocollab.od.mah.se/countriesalphab.html


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Distribution: Geographic

By Region in the US:

Variation within country

DMFS generally highest in Northeast, lowest in West, and

intermediate in Midwest and South

less distinct differences today than 50 years

ago

impact of fluorides and water fluoridation


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Distribution: Age

DMF scores increase with increasing age

DMF index is cumulative

(Decayed can become Filled, and then Missingthrough time)

Whole tooth missing due to dental caries isequal to a count of 4 or 5 surfaces in the

DMFS index Cohort effect


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Average Number of Dental Caries on PermanentTeeth Surfaces (DMF),Among Dentate Persons by Age11

0

10

20

30

40

50

60

70

80

90

'18-19 '20-29 '30-39 '40-49 '50-59 '60-69 '70+

Age

MeanDMFS


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Average Number of Root Caries Surfaces(Decayed or Filled) on Permanent Teeth AmongDentate Persons by Age11

0

0.5

1

1.5

2

2.5

3

'18-19 '20-29 '30-39 '40-49 '50-59 '60-69 '70+

Age

RootCaries


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Distribution: Gender

Females generally have higher DMFscores

Probable treatment effect females usually have higher Filled

component

Earlier tooth eruption among females

Cannot say females are moresusceptible to dental caries


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Average Number of Coronal Caries on Permanent TeethSurfaces, DMF, Among Dentate Persons by Gender andby Age11

0

10

2030

40

50

60

70

80

90

'Male

'F

emale

'Male

'F

emale

'Male

'F

emale

'Male

'F

emale

'Male

'F

emale

'Male

'F

emale

'Male

'F

emale

'18-

19

'18-

19

'20-

29

'20-

29

'30-

39

'30-

39

'40-

49

'40-

49

'50-

59

'50-

59

'60-

69

'60-

69

'70+ '70+

Mea

nDMFS

Age (years) by Gender


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Distribution: Race-Ethnicity

Little evidence for inherent differences indental caries susceptibility across race-ethnicity.

Differences in socioeconomic status associatedwith race-ethnicity in the U.S. are probablymore important.


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Distribution: Socioeconomic Status

SES relates to a persons background-values

Education

Income

Occupation

Most recent data suggest that DMFSscores are inversely related to SES


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Socioeconomic Status and Age Groups

15-24 years 35-44 years 55-64 years

Average DMFS Scores for Adults in Three

Socioeconomic Levels, 1988-949,11

0

10

20

3040

50

60

70

80

Low Middle High Low Middle High Low Middle High

Average DMFS

DecayedMissingFilled

9,11


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Percentage of adults aged 50 years and olderwith 21 or more teeth by race-ethnicity andfederal poverty level10,11

Age standardized to the year 2000 U.S. population.

4.2.3


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Distribution : Familial Patterns9

My family has bad teeth

May be a function of

Bacterial transmission

Family habits/ culture

diet

behavioral traits

Genetics (e.g., salivary flow, composition)

Additional research is needed


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Determinants: DentalCaries

Host (teeth)

Substrate (fermentable

carbohydrates) Flora (bacteria)

Time


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Determinants: Cariogenicity12

Cariogenicity is suggested to apply to gram-to-gram cariogenic potential for comparisons

Effective cariogenicity includes both the

gram-to-gram cariogenic potential and thefrequency and duration of exposure of theteeth

Fruits, in general, have very low or nocariogenic potential.


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Determinants: Diet & Dental Caries9

The intake of refined carbohydrates,especially refined sugars, is a risk factor forcaries,e.g.,

animal models human studies

Cooked or milled starches can be brokendown by salivary amylase and then serve as

a substrate for cariogenic bacteria

Uncooked / lightly cooked vegetables areconsidered virtually noncariogenic

D t l C i E i i


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Dental Caries Experience inOlder Adults13

Four large cohort studies of adultsaged 50 years or older Iowa

North Carolina Ontario

South Australia

Reports of coronal and root caries

At least a 3 year follow-up period


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Incidence and Increments of Coronal andRoot Caries in Older Adults13

Number atfollow-up

Observationperiod(years)

Coronal Caries Root Surface Caries BothCombined

Study Incidence Increment Incidence Increment Increment

Iowa 338 3 56% 2.4 (0.8)* 44% 1.1 (0.4) 3.5 (1.2)

NorthCarolina

3

Blacks 234 45% 1.6 (0.5) 29% 0.6 (0.2) 2.2 (0.7)

Whites 218 59% 2.1 (0.7) 39% 0.8 (0.3) 2.9 (1.0)

Ontario 493 3 57% 1.9 (0.6) 27% 0.6 (0.2) 2.5 (0.8)

SouthAustralia

528 5 67% 2.7 (0.5) 59% 2.2 (0.4) 4.9 (1.0)

Parentheses contain the annualized increment, computed by dividing the combined caries increment by the number of years of

follow-up, then rounding the result to 1 decimal place


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Risk Factors for Caries Developmentin Older Adults13

Coronal caries

No common risk factors

Suggested factors include low SES, and severity

of periodontal attachment loss at baseline

Root caries

Common risk factor was partial denture wearing

Other suggested factors include periodontalproblems and age

C i i S di h Old


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Caries in Swedish OlderAdults14

Methods

10-year incidence study

55, 65, and 75 years old at baseline

Measured coronal and root caries

Results

Higher incidence of coronal caries in youngest

age group (65 years old at conclusion of study) Higher incidence of root caries in oldest age

group (85 years old at conclusion of study)


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A State of Decay: The Oral Health ofOlder Americans15

September 2003: publication of an Oral Health AmericaSpecial Grading Project

http://www.oralhealthamerica.org/pdf/StateofDecayFinal.pdf

Overall National Grade: D

Vast majority of older Americans do not have dental

insurance coverage No Medicare dental coverage

Most state Medicaid programs only cover emergency-onlydental benefits: D+

71-80% do not have private dental insurance: D
http://www.oralhealthamerica.org/pdf/StateofDecayFinal.pdfhttp://www.oralhealthamerica.org/pdf/StateofDecayFinal.pdfhttp://www.oralhealthamerica.org/pdf/StateofDecayFinal.pdfhttp://www.oralhealthamerica.org/pdf/StateofDecayFinal.pdf


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Conclusions

As the number of missing teeth increase with

increased age, so do the number of surfacesaffected by dental caries

Older adults suffer from the accumulation ofcoronal and root caries over their lifetimes

Older adults have less dental insurance (Medicare

does not cover usual dental services), make fewerdental visits, and use more medication that maylead to decreased saliva (xerostomia)


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Biography

Susan G. Reed, DDS, MPH, DrPHis an AssistantProfessor of Stomatology, Director of the DentalPublic Health & Oral Epidemiology Section at theCollege of Dental Medicine. Her joint appointment iswith the Department of Biometry, Bioinformatics &

Epidemiology. Her dental degree is from CaseWestern Reserve University and she is a 1996graduate of the University of Michigan, School ofPublic Health where she completed her MPH,Residency in Dental Public Health, and was an NIHfellow for her doctorate in oral epidemiology. Dr. Reedis Board Certified in Dental Public Health. Herresearch interests include the epidemiology of oralcancer in SC, and oral Chlamydia trachomatisresearch.