Dental Caries and Root Caries Risk Assessment and Prevention

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Slide 1 :

Narumanas Korwanich Department of Community Dentistry Chiangmai University Dental Caries and Root Caries Risk Assessment and Prevention

Slide 2 :

Contents

Slide 3 :

WHO, 2002

Slide 4 :

UN, 2001

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Slide 7 :

WHO, 2002

Slide 8 :

Active Ageing

Slide 9 :

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

Slide 10 :

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

Slide 11 :

WHO, 2002

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Oral Health Problem in Elderly Petersen & Yamamoto, 2005

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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

Slide 14 :

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

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Company Logo Identify Risk Factor Dental Caries Prevalence

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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

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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

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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

Slide 20 :

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

Slide 21 :

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

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Slide 23 :

Petersen, 2005

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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

Slide 25 :

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

Slide 26 :

Tooth Substrate Microorganism Keyes’s diagram

Slide 27 :

Moynihan & Petersen, 2004

Slide 28 :

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)

Slide 29 :

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

Slide 30 :

Vipeholm Study Control group Sucrose group Bread group Chocolate group Caramel group 8 toffee group 24 toffee group

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The Vipeholm Study

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The Vipeholm Study

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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

Slide 34 :

Stephan’s Curve

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Slide 36 :

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

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Slide 38 :

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

Slide 39 :

Miravet et al., 2007

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Motohashi et al., 2006

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Slide 42 :

Slide 43 :

Scheie et al, 1996

Slide 44 :

Van Houte, 1993

Slide 45 :

Van Houte, 1993

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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

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Slide 48 :

Saliva affects all three of components of Keyes’ classic Venn Diagram of caries etiology Dodd et al., 2005

Slide 49 :

Lenander-Lumikari & Loimaranta, 2000

Slide 50 :

Tanathipanont & Korwanich, 2008

Slide 51 :

Lenander-Lumikari & Loimaranta, 2000 Buffer Capacity

Slide 52 :

Klienberg et al., 1973 Flow Rate

Slide 53 :

Commercial kits for saliva and microbial test

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Resazurin Disc (RD) test

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Slide 67 :

Other commercial kits Caries Screen Proflow Oricult Mucount

Slide 68 :

Consideration for Root Caries Thompson, 2004

Slide 69 :

Unit : surface

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Slide 71 :

Slide 72 :

Saunders & Meyerowitz, 2005

Slide 73 :

Putting them together

Slide 74 :

Fejerskov & Manji 1990

Slide 75 :

Cariogram

Slide 76 :

Miravet et al., 2007

Slide 77 :

Caries Prevention Walsh, 2004

Slide 78 :

Reduce the pathogenic potential of dental plaque

Slide 79 :

Augment salivary factors

Slide 80 :

Increase tooth structure resistance to caries attack

Slide 81 :

Slide 82 :

Slide 83 :

Slide 84 :

Thank You !

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