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Narumanas Korwanich Department of Community Dentistry Chiangmai University Dental Caries and Root...
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Transcript of Narumanas Korwanich Department of Community Dentistry Chiangmai University Dental Caries and Root...
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