4dental Caries. Determination. Epidemiology

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, advantages
and failings. Concept of functionally structural
resistence of hard tissues of tooth.
Lecturer: as. Yavorska-Skrabut I.M.
Therapeutic dentistry department
The Epidemiology of
Dental Caries in
Older Adults
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
Learning Objectives
At the conclusion of this module, the
participant 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

Supplemental Documents
The Pre-Post Test Question with
answers, References, and Evaluation
Form for this module are found on a
separate MS Word document.
Epidemiology
1

Epidemiology is the study of the
Distribution and
Determinants of
Disease/health in a population

Definition mnemonic 3Ds

Disease: Dental Caries
2-4

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/Princi
ples.

How to measure dental caries?
DMFT and DMFS
http://www.whocollab.od.mah.se/expl/orhdmft.
html

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 Caries
Dental enamel
Root
surface
Root caries
Disease: Dental Caries
5-8

How to count dental caries for a
population?
U.S. National Surveys
NHANES, HHANES, NOHSS
http://www.cdc.gov/nchs/nhanes.htm
http://www.cdc.gov/nohss/sealants/surveys.htm

NIDCR/CDC Dental, Oral, and Craniofacial Data
Resource Center
http://drc.nidcr.nih.gov/default.htm

A Brief History of Dental Caries
9

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 developed
countries

Brief History of Dental Caries
9

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

Distribution: Dental
Caries
Geographic
Age

Gender

Race / ethnicity

Socioeconomic status

Familial patterns
Distribution: Geographic
10

By Country
http://www.whocollab.od.mah.se/countriesalphab.html
#Top
Variation among countries

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

Distribution: Age

DMF scores increase with increasing age
DMF index is cumulative
(Decayed can become Filled, and then Missing
through time)
Whole tooth missing due to dental caries is
equal to a count of 4 or 5 surfaces in the
DMFS index
Cohort effect

Average Number of Dental Caries on Permanent
Teeth Surfaces (DMF),
Among Dentate Persons by Age
11

0
10
20
30
40
50
60
70
80
90
'18-19 '20-29 '30-39 '40-49 '50-59 '60-69 '70+
Age
M
e
a
n

D
M
F
S
Average Number of Root Caries Surfaces
(Decayed or Filled) on Permanent Teeth Among
Dentate Persons by Age
11
0
0.5
1
1.5
2
2.5
3
'18-19 '20-29 '30-39 '40-49 '50-59 '60-69 '70+
Age
R
o
o
t

C
a
r
i
e
s
Distribution: Gender
Females generally have higher DMF
scores
Probable treatment effect
females usually have higher Filled
component
Earlier tooth eruption among females
Cannot say females are more
susceptible to dental caries

Average Number of Coronal Caries on Permanent Teeth
Surfaces, DMF, Among Dentate Persons by Gender and
by Age
11
0
10
20
30
40
50
60
70
80
90
'
M
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e
'
F
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'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+
M
e
a
n

D
M
F
S
Age (years) by Gender
Distribution: Race-Ethnicity
Little evidence for inherent differences in
dental caries susceptibility across race-
ethnicity.

Differences in socioeconomic status associated
with race-ethnicity in the U.S. are probably
more important.
Distribution: Socioeconomic Status

SES relates to a persons background-
values
Education
Income
Occupation

Most recent data suggest that DMFS
scores are inversely related to SES

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
30
40
50
60
70
80
Low Middle High Low Middle High Low Middle High
Average DMFS
Decayed
Missing
Filled
9,11

Percentage of adults aged 50 years and older
with 21 or more teeth by race-ethnicity and
federal poverty level
10,11

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

4.2.3
Distribution : Familial Patterns
9

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
Determinants: Dental
Caries
Host (teeth)
Substrate (fermentable
carbohydrates)
Flora (bacteria)
Time
Determinants: Cariogenicity
12

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

Effective cariogenicity includes both the
gram-to-gram cariogenic potential and the
frequency and duration of exposure of the
teeth

Fruits, in general, have very low or no
cariogenic potential.
Determinants: Diet & Dental Caries
9

The intake of refined carbohydrates,
especially refined sugars, is a risk factor for
caries,
e.g.,
animal models
human studies

Cooked or milled starches can be broken
down by salivary amylase and then serve as
a substrate for cariogenic bacteria
Uncooked / lightly cooked vegetables are
considered virtually noncariogenic

Dental Caries Experience in
Older Adults
13

Four large cohort studies of adults
aged 50 years or older
Iowa
North Carolina
Ontario
South Australia

Reports of coronal and root caries
At least a 3 year follow-up period
Incidence and Increments of Coronal and
Root Caries in Older Adults
13

Number at
follow-up
Observation
period
(years)
Coronal Caries Root Surface Caries Both
Combined
Study Incidence Increment Incidence Increment Increment
Iowa 338 3 56% 2.4 (0.8)* 44% 1.1 (0.4) 3.5 (1.2)
North
Carolina
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)
South
Australia
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
Risk Factors for Caries Development
in Older Adults
13

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 periodontal
problems and age
Caries in Swedish Older
Adults
14

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)

A State of Decay: The Oral Health of
Older Americans
15

September 2003: publication of an Oral Health America
Special Grading Project

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

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-only
dental benefits: D+
71-80% do not have private dental insurance: D
Conclusions
As the number of missing teeth increase with
increased age, so do the number of surfaces
affected by dental caries

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

Older adults have less dental insurance (Medicare
does not cover usual dental services), make fewer
dental visits, and use more medication that may
lead to decreased saliva (xerostomia)

Biography
Susan G. Reed, DDS, MPH, DrPH is an Assistant
Professor of Stomatology, Director of the Dental
Public Health & Oral Epidemiology Section at the
College of Dental Medicine. Her joint appointment is
with the Department of Biometry, Bioinformatics &
Epidemiology. Her dental degree is from Case
Western Reserve University and she is a 1996
graduate of the University of Michigan, School of
Public Health where she completed her MPH,
Residency in Dental Public Health, and was an NIH
fellow for her doctorate in oral epidemiology. Dr. Reed
is Board Certified in Dental Public Health. Her
research interests include the epidemiology of oral
cancer in SC, and oral Chlamydia trachomatis
research.

4dental Caries. Determination. Epidemiology

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Medical University of South Carolina/SC-Geriatric Education Center

Dental caries. Determination. Epidemiology of

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