Community Dentistry Third Year

1. ‫بسم ال الرحمن الرحيم‬
Measuring dental
caries
Introduction to Community Dentistry
PDS 372

2. Lecture outline
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DMF index
Criteria for diagnosing coronal caries
Root caries
Early childhood caries
Caries treatment needs

3. Pathogenesis of Dental Caries
(biological balances)
SALIVA
PLAQUE
PLAQUE
ENAMEL
ENAMEL
Polysaccharides
Calcium
Salts
Plaque
buffers
mouth
SUGARS
inside of tooth
ACID
Calcium
Salts
Bacterial
Enzymes
Salivary
buffers
Demineralization
Re-mineralization

4. Methods of measuring dental caries in the
early 20th century:
 The proportion of first molars lost through
caries
 The percentage of erupted permanent
teeth affected by caries

5. 
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Bodecker’s index
Dean and colleagues count
Klein, Palmer and Knutson DMF index

6. DMF index
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Universal acceptance
Best known and most widely used dental
index
What is an index?
Is a numerical scale with upper and lower
limits, with scores on the scale
corresponding to specific criteria

7. Properties of an ideal index
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Validity
Reliability
Clarity, simplicity, and objectivity
Quantifiability
Sensitivity
Acceptability

8. DMF index
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Is an irreversible index
Applied only to permanent teeth
D
M
F

9. DMF index
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It ranges from 0 to 32
Decimal DMF
DMFT vs. DMFS
Modifications can be made
Half mouth approach
32 teeth vs. 28 teeth
DMF vs. def

10. 
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The DMFT index is one of the simplest and most
commonly used indices in epidemiologic surveys
of dental caries.
It quantifies dental health status based on the
number of carious, missing and filled teeth .
The index, however, does not provide an
accurate description of previous dental care . Nor
does it provide information regarding the severity
of the carious attack or the indicated treatment .

11. Limitations of the DMF index
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DMF values are not related to the number of teeth at risk
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It has no denominator
Age must be stated
DMF index gives equal weight to missing, untreated
decayed, and well-restored teeth
DMF index is invalid when teeth have been lost for
reasons other than caries
DMF index can overestimate caries experience in teeth
with “preventive restorations”
DMF data not useful for estimating treatment needs
DMF index can not account for sealed teeth

12. def index
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Teeth missing because of caries are not
recorded
Modifications to this index includes:
It should be used in children before the age of
exfoliation
 Applied to only primary molars
 The df index
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13. DMF index
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Because of the present day skewed
distribution of dental caries prevalence,
the Significant Caries Index (SiC Index)
was developed
A global goal of an SiC score of 3.0 or less
for 2015

14. Other teeth indices
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Grainger’s hierarchy, an ordinal scale with 5
zones of severity attack
FS-T, sums the sound and healthy restored
teeth
T-Health, measures healthy dental tissues and
assigns descending numerical weights
Sealed teeth DMFS vs. DMFSS
A measure of caries activity vs. treatment
received

15. Criteria for diagnosing coronal
caries
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Cavitated vs. non-cavitated
Borderline lesions
Reversible vs. irreversible
Dentinal vs. enamel caries
Visual-tactile vs. visual only
The use of radiographs
Latest technologies in caries detection

16. Criteria for diagnosing coronal
caries
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Diagnosis through the full range of caries,
the D1-D3 scale:
0. Surface sound
D1. Initial caries
D2. Enamel caries
D3. Caries of dentin
D4. Pulpal involvement

17. Criteria for diagnosing coronal
caries
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1.
2.
3.
Diagnosis at the dental lesion stage only,
the dichotomous scale:
Catches that are accompanied by:
Softness at the base of the area
Opacity adjacent to the area
Softened enamel adjacent to the area

18. Terminology for dental decay (caries)
established decay
decay into
dentine
obvious decay
experience
(%d3mft/D3MFT)
Unseen
dentine
decay
early stage decay
very early
stage decay
Visible enamel decay
Sub-clinical decay
Unseen
enamel
Decay
excludes all
enamel lesions

19. Recording visual caries at the dentine level
SIMPLER TERMS
DENTISTS’ TERMS
Traditional
indicator now
termed:
severe decay
Pulpal decay
obvious
decay
into
dentine
established decay
Dentine decay
Unseen
dentine
decay
Groups and Individuals with
“No Obvious Decay”
should NOT be called “Caries Free”
Proportion
with no obvious
decay experience

20. Root caries

21. Root caries
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Criteria for diagnosing root caries
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Root caries activity, the Root Caries Index
(RCI) scores
(Root surfaces: decayed + filled) X 100 /
(Root surfaces with loss of periodontal
attachment: decayed + filled + sound)
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22. Early childhood caries

23. Early Childhood Caries
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Baby bottle tooth decay
Nursing caries
Labial caries
Dietary associations
Exposure to sugar
Case definition

24. Early childhood caries
Ages in months ECC
Severe ECC
<12
1 or more dmf surfaces
1 or more smooth dmf
surfaces
12-23
1 or more dmf surfaces
1 or more smooth dmf
surfaces
24-35
1 or more dmf surfaces
1 or more smooth dmf
surfaces
36-47
1 or more dmf surfaces
Anterior teeth involved
and dmfs ≥ 4
48-59
1 or more dmf surfaces
Anterior teeth involved
and dmfs ≥ 5
60-71
1 or more dmf surfaces
Anterior teeth involved
and dmfs ≥ 6

25. Caries treatment needs
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The D component of the DMF should be
the guide for treatment
Not suitable for the following reasons:
Survey vs. clinical criteria
 Patients’ perceived needs and willingness to
pay for treatment
 Judgment over the caries activity
 Treatment philosophies change with time
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26. Caries treatment needs
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Caries assessment in the field vs. the
clinic
The WHO includes a subjective treatment
need assessment by the examiner as part
of the pathfinder survey method
A situation analysis in low-income
countries

27. Questions?