This document provides an overview of dental caries (tooth decay), including its global distribution, risk factors, and specific types. It discusses how caries prevalence has historically changed and varies globally depending on diet and lifestyle. Key points covered include the role of bacteria, diet (particularly sugars and starches), and socioeconomic status as risk factors. Specific sections address secular trends in caries among children in developed nations, demographic influences, root caries in elderly populations, and early childhood caries.

1. Dental caries
PDS 372

2. Lecture outline
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Global distribution of dental caries
Secular variations in caries experience
Uneven distribution of caries
Demographic factors
Risk factors and risk indicators
Root caries
Early childhood caries

3. Introduction
• Dental caries is an ancient disease
• Attrition surpassed caries formation
• The modern pattern of caries in the highincome nations (16th century):
– lesion began on fissured surfaces, later
develop on proximal surfaces.
• Dietary changes and dental caries
– UK - import of sugar and dental caries
increase

4. Global distribution of dental caries
• Historic pattern change with adopting new
cariogenic diets and lifestyles of the developed
world
• In the 20th century, Disease of the high-income
countries…. Why? Diet*
• By the later 20th century
– Caries experience in low income-countries had risen
post WWII
– Marked reduction in caries experience among
children and young adults in high-income countries

5. WHO and the global oral health
data bank
Country
Initial DMFT
China
Cuba
Morocco
Saudi Arabia
Thailand
0.8
2.9
2.3
2.0
1.5
Initial year
1983
1989
1991
1985
1984
Latest DMFT
1.0
1.4
2.5
1.7
1.6
Latest year
1996
1998
1999
1995
2001
http://www.worldbank.org/data/countryclass/classgroups.htm

6. Secular variations in caries
experience
• Caries prevalent, teeth are affected within
2-4 years of eruption
• Reduction in caries with children of highincome nations
• Problems exist with disparities
• Greater reduction of incidence in smooth
surfaces and proximal surfaces vs.
occlusal*

7. • Pit and fissure lesions and the use of
sealants
• Caries decline…reasons?
– Fluorides
– Better oral hygiene
– Changes in bacterial ecology
– Pediatric antibiotics

8. • In high-income nations, reduction of caries
led to the generations of “caries-free”
children
• Yet, there are the underprivileged who
need to be addressed
– DMFS of 7 or higher: severe disease
• Free of caries requiring restorative
treatment

9. • Age
Demographic factors
– Dental caries increase ?
• DFM increase with age: more F in children and more M in adults
– missing teeth
– Childhood disease ?was
– Lifetime disease?
• yes, especially in communities with lower attack rate.
• Gender
– Female more ?y n studies, not reality
– *Early eruption
– *More restored teeth (treatment factor)
– More dental visits
– Men have more untreated teeth

10. Demographic factors
• Race and ethnicity
– Inherent is not a reason
– Environmental is
– Migration is: to area w diff diet
– Socioeconomic differences are far more important
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Education
Self-care practices
Attitudes
Values
Income
access to health care

11. Demographic factors
• Socioeconomic Status (SES)
– Social class (UK)
– Is a broad recording of an individual’s
attitudes and values as measured by factors
such as
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Education
Income
Occupation
Place of residence

12. Demographic factors
• Socioeconomic Status (SES)
– is inversely related to disease
– Aspect of treatment differ bet. SES classes
– Dental caries is a disease of poverty? Y now
– Consider SES when planning public health
programs
– Fluoridation reduce the diff bet classes, but
not remove it.

13. Demographic factors
• Familial and genetic patterns
– Familial tendencies
• Bad teeth run in families
• Does it: genetic basis, bacterial transmission,
familial dietary, behavioral traits.
– mother to infant bacteria transmission
– Identical twins study: env. factors are stronger
– Salivary flow and composition, tooth
morphology and arch width are genetically
determined

14. Risk factors and risk indicators
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Bacteria
Diet
Plaque deposits
Saliva quantity and quality
Enamel quality
Tooth morphology

15. Risk factors and risk indicators
• Bacterial infection
– Necessary for caries formation
– Most common flora: Strep mutans, Lactobacilli.
– Ecologic imbalance rather than exogenous
infection
– Carbohydrate-modified bacterial infectious
disease
– High +ve count is a poor predictor of future caries

16. Risk factors and risk indicators
• Nutrition and caries
– Diet
• Total oral intake of substance that provide energy and
nourishment.
– Nutrition
• Absorption of nutrients.
• Vitamin D deficiency: hypoplasia and caries
• Severe malnutrition during the first year of life:
delay eruption, exfoliation, reduce saliva flow.
• Exposure to western diet

17. Risk factors and risk indicators
• Diet and caries: clear influence
– Refined carbs: Sugars
– Sugar-starch mixtures (more cario than sugar alone)
– Primitive races and caries experience: eating
hard fibrous unprocessed food: better jaw and
teeth development.
– Miller (19th century)
• Chemoparasitic theory (based on action of MO on
fermentable carb that adhere to tooth suraface)
– Protective food

18. Risk factors and risk indicators
• Diet and caries
– Epidemiologic studies
• WWII studies: Japan, Norway, UK
– delayed eruption after rationing. Less caries.
• Hopewood house:
– children on vege diet: 53% have no detectable caries
compared with others 0.4%
• Hereditary Fructose Intolerance:
– they have no caries
• Vipeholm study:
– grps w ctrled comsumption of refined sugar vary in: amount,
freq, phys form, time of consumption. Sticky sugar between
the meals increase the caries.
• Caries and soft drinks:
– sugar in liquid form is cariogenic

19. Root caries
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Location (cementum if recession)
Polymicrobial
Sugar are part of the etiology
Prevalent in elderly in hi income
Men are more affected
Linked to periodontal attachment
With increase tooth retention, susceptible root
surfaces are increased
• Less in hi fluoride ares.
• More in smokers

20. Early childhood caries
• Definition (any before 6 yo)
– Severe caries in maxillary incisors
• Incidence rates
– In lower SES: lower education
– At greater risk of permanent caries
• Research: not linked with bottled milk
– Prolonged exposure to liquid with sugars.
• Prevention: education