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8/2/2019 Epidemiology of Dental Caries(5)
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EPIDEMIOLOGY OF DENTAL
CARIES
Dr.Ghada MaghairehBDS,MS,ABOD
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Dental caries is an ancient disease, it hasafflicted human at least from the time thatagriculture replaced hunting.
Dietary changes during the 17th centuryprincipally increased refinement and greater useof sucrose are considered chiefly responsible forthe development of modern pattern of dentalcaries.
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Global Distribution
Dental caries used often to be referred to as the
disease of civilization.
This expression was used to describe theprevailing pattern of caries observed during
most of the 20th century: high prevalence of the
developed countries, low prevalence in the
developing world.
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Global Distribution
There are several interrelated reasons why this historicalpattern developed.
The most obvious reason is diet; the high level ofconsumption of refined carbohydrates in developedcountries has long been synonymous with good life.
Poorer societies, however, survived on hunting and onsubsistence farming, both of which provide diet, low infermentable carbohydrates.
A related reason concerns the evolution of proliferationof cariogenic bacteria under the selective pressure ofsuitable diet.
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Global Distribution
By the late 20th century, however, this traditional
pattern was changing in two ways.
First, there was evidence that the prevalence andintensity of dental caries in many developing
countries were rising sharply.
Second, change is an equivocal, marked reduction incaries experience among children and young adults
in developed countries.
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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.
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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.
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Decline in Dental Caries
Data from 9 different countries all appointed tothe same conclusion, namely, that cariesexperience in children has declined considerably
over generation or so.
An important aspect of caries decline is its effecton different tooth surfaces.
In US study 81% of all new carious lesions wereon occlusal surfaces and pit and fissures ofbucccal and lingual molar surfaces.
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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
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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.
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Distribution of Caries Severity
There is no generally acceptable definition of severecaries.
However, DMF value of 7 or more considered severecaries in children.
In US children up to age 17, there were 27.3% ofchildren have severe caries (DMF>=7) in 1979-1980survey.
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 teethare found in about 12% of children, and over 75% of all
affected teeth are in less than 25% of children.
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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.
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Determinants and Risk Factors for
Dental Caries
Age:
Mean DMF increases with age.
In the childhood there is high caries rate and inelderly there is high percentage of missing due tocaries.
However, new research demonstrated that cariousattack is likely to spread out more through outlife, and there is evidence that older adults candevelop new carious lesions.
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Sex:
Females generally demonstrate higher DMF scores thando males, although this finding is not universal.
The difference is small enough to be explained by earliereruption of teeth in females, their teeth at risk in oralenvironment 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 inDMF values between males and females.
Determinants and Risk Factors for Dental
Caries
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Race and Ethnicity:
Contentions that certain races enjoy a high degree of resistance todental caries have been around for a long time.
These assertions have faded as the evidence mounts that globaldifferences in caries experience are more a result of environmentthan they are of inherent racial attributes.
The overall pattern that emerges from data from different studiesis that there is no basis for believing in inherent differencebetween races and ethnicity.
Socioeconomic differences, which means differences in education,self-care, attitude, values, available income, and access to healthcare, appear to be far more important determinant.
Determinants and Risk Factors for Dental
Caries
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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.
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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 suchtendencies have any genetic basis or weather they onlyrepresent bacterial transmission or continuing familialdietary or behavioral traits.
Husband-wife similarities clearly have no genetic origin,and intrafamilial transmission of cariogenic bacteria hasalso been shown to occur.