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Dental Caries and Root Caries Risk Assessment and Prevention. Narumanas Korwanich Department of Community Dentistry Chiangmai University. Introduction. 1. Caries risk assessment. 2. Caries prevention. 3. Conclusion. 4. Contents. WHO, 2002. UN, 2001. WHO, 2002. Active Ageing.

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dental caries and root caries risk assessment and prevention

Dental Caries and Root Caries Risk Assessment and Prevention

Narumanas Korwanich

Department of Community Dentistry

Chiangmai University

contents

Introduction

1

Caries risk assessment

2

Caries prevention

3

Conclusion

4

Contents
active ageing
Active Ageing

When the risk factors for chronic diseases and functional decline are kept low while the protective factors are kept high, people will enjoy both a longer quantity and quality of life

Health

When labor market, employment, education, health and social policies and programs support their full participation in socio-economic, cultural and spiritual activities, people will continue to make a productive contribution to society

Participation

When policies and program address the social, financial and physical security needs and rights of people as they age, elderly are ensured of protection, dignity and care in the event that they are no longer able to support and protect themselves

Security

slide9
Oral health is an important component of ‘Active Ageing’ and is included in policy proposals related to health, one of the three basic pillars.

Petersen & Yamamoto, 2005

slide10
Reduce risk factors associated with major diseases and increase factors that protect health throughout the life course

- Tobacco - Physical activity

- Nutrition - Healthy eating

- Oral Health - Psychological factors

- Alcohol and drugs - Medication

oral health problem in elderly
Oral Health Problem in Elderly

Tooth loss

Xerostomia

1

5

Denture related condition

Cancer and precancer

2

6

Coronal and root caries

3

Periodontal disease

4

Petersen & Yamamoto, 2005

dental caries
Dental Caries
  • Dental caries is an infectious, communicable disease resulting in destruction of tooth structure by acid-forming bacteria found in dental plaque, in the presence of sugar
  • During the past few decades, changes have been observed not only in the prevalence of dental caries, but also in the distribution and pattern of the disease in the population

NIH, 2001

dental caries14
Dental Caries
  • It is identified a shift toward improved diagnosis of noncavitated, incipient lesions and treatment for prevention and arrest of such lesions
  • Restorations repair the tooth structure, do not stop caries, have a finite life span and are susceptible to disease

Fontana and Zero, 2006

slide15

Diagnosis

Distribution

Pattern

Identify Risk Factor

Dental Caries

Prevalence

Company Logo

risk factors
Risk factors
  • An environmental, behavioral, or biologic factor confirmed by temporal sequence, usually in longitudinal studies, which if present directly increases the probability of a disease occurring, and if absent or removed reduces the probability
  • Risk factors are part of the causal chain or expose the host to the causal chain
  • Once disease occurs, removal of a risk factor may not result in a cure

Beck, 1996

caries risk assessment
Caries Risk Assessment
  • Caries risk assessment determines the probability of caries incidence in a certain period
  • Modern caries management also focuses on the detection of incipient, non-cavitated lesions and the practitioner’s ability to diagnose whether those lesions are active
caries risk assessment19
Caries Risk Assessment
  • Evaluate the degree of patient’s risk of developing caries to determine the intensity of the treatment and frequency of recall appointments or treatment
  • Help identify the main etiologic agents that contribute to the disease or that, because of their recent onset, may contribute to future disease, to determine the type of treatment
caries risk assessmemt
Caries Risk Assessmemt
  • Determine if additional diagnostic procedures are required
  • Aid in restorative treatment decision
  • Improve the reliability of the prognosis of the planned treatment
  • Assess the efficacy of the proposed management and preventive treatment plan at recall visits
slide21

1

2

3

4

Prediction based on socio-economic status,

oral hygiene and dietary factors

Prediction based on behavioral factors

Prediction based on past caries experience

Prediction based on salivary factors and

microbial colonization

Messer, 2000

slide22

Caries Experience

Behavior

Microbial

Colonization

SES,

Oral Hygiene,

Diet

Saliva

slide24
Low indices of socioeconomic status (SES) have been associated with elevations in caries, although the extent to which this indicator may simply reflect previous correlates is unknown
  • Low SES is also associated with reduced access to care, reduced oral health aspirations, low self efficacy, and health behaviors that may be enhance caries risk

NIH 2002

slide25
Diet
  • Sugar exposure is important factor in caries development
  • Frequency and amount of sugar intake has been shown related to dental caries incidence
slide26

Tooth

Microorganism

Substrate

Keyes’s diagram

slide28
The best available evidence indicates that the level of dental caries is low in countries where the consumption of free sugar is below 15–20 kg/person/yr. This is equivalent to a daily intake of 40–55 g and the values equate to 6–10% of energy intake.
  • Individuals should be recommended to reduce the frequency with which they consume foods containing free sugars to four times a day and thereby limit the amount of free sugars consumed

(European workshop on oral care and general health, 2003)

vipeholm study
Vipeholm Study
  • 1945-1953
  • 964 mentally deficient patients
  • Sugars and potential in caries induction
    • Non sticky form
    • Sticky form
    • Between meal and sticky form
  • 1 control and 6 main test groups
vipeholm study30
Vipeholm Study
  • Control group
  • Sucrose group
  • Bread group
  • Chocolate group
  • Caramel group
  • 8 toffee group
  • 24 toffee group
the vipeholm study33
The Vipeholm Study
  • Sugar has a topical effect on teeth
  • Bread is not as cariogenic as sugar
  • The amount of sugar is not critical
  • The frequency of eating is more important
  • Liquid sweet are not as cariogenic as retentive sweet
  • Carious lesions occurred despite avoidance of sugar
slide35

Microbial

Colonization

Caries

Experience

Saliva

Behavior

SES,

Oral Hygiene,

Diet

slide36
Age

Nocturnal bottle usage

Additive

On pacifier during sleep

Breast feeding

Ho and Messer, 1993

Breast feeding

Bottle feeding

Regularity of snacks

Drinking sweet beverage

Watching television during meal

Brushing by mother

Kawabata et al., 1997

slide37

Saliva

Microbial

Colonization

SES,

Oral Hygiene,

Diet

Caries

Experience

Behavior

slide38
Thus far, the most consistent predictor of caries risk in children is past caries experience

NIH, 2001

  • Previous caries experience was an important predictor in most models tested for primary, permanent and root surface caries

Zero et al., 2001

slide41

SES,

Oral Hygiene,

Diet

Saliva

Behavior

Microbial

Colonization

Caries

Experience

slide42

Ecological Plaque

Other oral bacteria are sufficiently acidogenic.

Adherence of plaque without mutan streptococci.

Mutan streptococci

Lactobacilli

Innoculation of S.mutans shows higher caries activity.

High acid production activity of S.mutans

Association of Lactobacilli and dental caries.

Association of Lactobacilli and fermentable carbohydrates.

slide46
Overall, the data in the table indicate that the prediction of high caries risk in children, including the very young and adolescents, on the basis of a single microbial factor is problematic, whereas prediction of low caries risk is more reliable

Van Houte, 1993

slide47

Behavior

SES,

Oral Hygiene,

Diet

Caries

Experience

Saliva

Microbial

Colonization

slide48
Saliva affects all three of components of Keyes’ classic Venn Diagram of caries etiology

Dodd et al., 2005

slide50

Salivary Flow Rate

Xerostomia

subjective report of oral dryness related to gender

Hyposalivation

Objective salivary flow rate that is under 0.1 or 0.16 ml/min (or 0.1 ml/min; relate to medication and systemic disease

Tanathipanont & Korwanich, 2008

buffer capacity
Buffer Capacity

Lenander-Lumikari & Loimaranta, 2000

flow rate
Flow Rate

Klienberg et al., 1973

other commercial kits
Other commercial kits
  • Caries Screen
  • Proflow
  • Oricult
  • Mucount
consideration for root caries
Consideration for Root Caries

Older people are a caries-active group, experiencing new disease at a rate which is as great as that of adolescents

1

The risk factor common to all studies about root caries was the wearing of a partial denture.

2

Thompson, 2004

caries prevention
Caries Prevention

1

2

3

Reduce the pathogenic potential of dental plaque

Increase the resistance of tooth structure to caries attack

Augment salivary factors

Walsh, 2004

reduce the pathogenic potential of dental plaque
Reduce the pathogenic potential of dental plaque

Mechanical plaque control

Sugar frequency reduction

1

5

Chemotherapeutic method

2

Food intake restriction

3

Replacement sweetener

4

augment salivary factors
Augment salivary factors

Sugar free chewing gum

Enhance F in saliva

1

5

Supportive life style

2

Elevate salivary quality

3

Increase saliva mineralization

4

increase tooth structure resistance to caries attack
Increase tooth structure resistance to caries attack

Community fluoride program

Enamel treatment

1

5

Professional fluoride

2

Self application fluoride

3

Sealant

4

slide81

Bactericide

Mode of Action

Crystallize

Remineralize