Narumanas KorwanichDepartment of Community Dentistry

Chiangmai University

Dental Caries and Root Caries Risk Assessment and

Prevention

Contents

Introduction1

Caries risk assessment2

Caries prevention3

Conclusion4

WHO, 2002WHO, 2002

UN, 2001UN, 2001

WHO, 2002WHO, 2002

Active Ageing

HealthHealthWhen 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

ParticipationParticipationWhen 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

SecuritySecurity

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

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, 2005Petersen & Yamamoto, 2005

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

WHO, 2002WHO, 2002

Oral Health Problem in Elderly

Tooth loss1

Denture related condition2

Coronal and root caries3

Periodontal disease4

Xerostomia5

Cancer and precancer6

Petersen & Yamamoto, 2005Petersen & Yamamoto, 2005

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, 2001NIH, 2001

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, 2006Fontana and Zero, 2006

Company Logo

Identify Risk FactorIdentify Risk FactorIdentify Risk FactorIdentify Risk Factor

Dental Caries

DistributionDistribution DiagnosisDiagnosisPatternPattern PrevalencePrevalence

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, 1996Beck, 1996

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 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

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

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 andmicrobial colonization

Messer, 2000Messer, 2000

MicrobialColonization

Caries ExperienceBehavior

SES, Oral Hygiene,

DietSaliva

Petersen, 2005Petersen, 2005

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 2002NIH 2002

Diet

Sugar exposure is important factor in caries development

Frequency and amount of sugar intake has been shown related to dental caries incidence

Tooth

Substrate

Microorganism

Keyes’s diagram

Moynihan & Petersen, 2004Moynihan & Petersen, 2004

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

1945-1953964 mentally deficient patientsSugars and potential in caries induction

Non sticky form Sticky form Between meal and sticky form

1 control and 6 main test groups

Vipeholm Study

Control group Sucrose group Bread groupChocolate groupCaramel group8 toffee group24 toffee group

The Vipeholm Study

The Vipeholm Study

The Vipeholm Study

Sugar has a topical effect on teethBread is not as cariogenic as sugarThe amount of sugar is not criticalThe frequency of eating is more importantLiquid sweet are not as cariogenic as

retentive sweetCarious lesions occurred despite

avoidance of sugar

Stephan’s Curve

Saliva

MicrobialColonization Caries

Experience

Behavior

SES,Oral Hygiene,

Diet

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

SES,Oral Hygiene,

Diet

SalivaMicrobial

Colonization

CariesExperience

Behavior

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

Miravet et al., 2007Miravet et al., 2007

Motohashi et al., 2006Motohashi et al., 2006

Behavior

SES,Oral Hygiene,

DietSaliva

MicrobialColonization

CariesExperience

Mutan streptococci

Ecological Plaque

Lactobacilli

Association of Lactobacilli and dental caries. Association of Lactobacilli and fermentable carbohydrates.

Innoculation of S.mutans shows higher caries activity.High acid production activity of S.mutans

Other oral bacteria are sufficiently acidogenic.Adherence of plaque without mutan streptococci.

Scheie et al, 1996

Van Houte, 1993Van Houte, 1993

Van Houte, 1993Van Houte, 1993

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, 1993Van Houte, 1993

Caries Experience

BehaviorSES,

Oral Hygiene,Diet

Saliva

MicrobialColonization

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

Dodd et al., 2005

Lenander-Lumikari & Loimaranta, 2000Lenander-Lumikari & Loimaranta, 2000

Xerostomiasubjective report of

oral dryness related to gender

Salivary Flow Rate

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, 2008Tanathipanont & Korwanich, 2008

Lenander-Lumikari & Loimaranta, 2000Lenander-Lumikari & Loimaranta, 2000

Buffer Capacity

Klienberg et al., 1973Klienberg et al., 1973

Flow Rate

Commercial kits for saliva and microbial testCommercial kits for saliva and microbial test

Resazurin Disc (RD) testResazurin Disc (RD) test

Other commercial kits

Caries ScreenProflowOricultMucount

Consideration for Root Caries

11Older people are a caries-active group, experiencing new disease at a rate which is as great as that of adolescents

22The risk factor common to all studies about root caries was the wearing of a partial denture.

Thompson, 2004Thompson, 2004

Unit : surfaceUnit : surface

Saunders & Meyerowitz, 2005Saunders & Meyerowitz, 2005

Putting them togetherPutting them together

Fejerskov & Manji 1990Fejerskov & Manji 1990

CariogramCariogram

Miravet et al., 2007Miravet et al., 2007

Caries Prevention

1

Reduce the pathogenic potential of

dental plaque

2

Increase the resistance of

tooth structure to caries attack

3

Augment salivary factors

Walsh, 2004Walsh, 2004

Reduce the pathogenic potential of dental plaque

Mechanical plaque control1

Chemotherapeutic method2

Food intake restriction3

Replacement sweetener4

Sugar frequency reduction 5

Augment salivary factors

Sugar free chewing gum1

Supportive life style2

Elevate salivary quality3

Increase saliva mineralization4

Enhance F in saliva 5

Increase tooth structure resistance to caries attack

Community fluoride program1

Professional fluoride2

Self application fluoride3

Sealant4

Enamel treatment 5

Mode of ActionMode of Action

BactericideBactericide

CrystallizeCrystallize

RemineralizeRemineralize