EPIDEMIOLOGY OF DENTAL CARIES

Dr.Ghada Maghaireh
(Lecture Outline)

Dental caries is an ancient disease, it has afflicted human at least

from the time that agriculture replaced hunting.

Dietary changes during the 17th century principally increased

refinement and greater use of sucrose are considered chiefly
responsible for the development of modern pattern of dental
caries.

Global Distribution
Dental caries used often to be referred to as the disease of
civilization.
Without getting into who is civilized and who is not, this expression
was used to describe the prevailing pattern of caries observed
during most of the 20th century: high prevalence of the developed
countries, low prevalence in the developing world.
There are several interrelated reasons why this historical pattern
developed.
The most obvious reason is diet; the high level of consumption of
refined carbohydrates in developed countries has long been
synonymous with good life.
Poorer societies, however, survived on hunting and on subsistence
farming, both of which provide diet, low in fermentable
carbohydrates.
A related reason concerns the evolution of proliferation of
cariogenic bacteria under the selective pressure of suitable diet.
By the late 20th century, however, this traditional pattern was
changing in two ways.
First, there was evidence that the prevalence and intensity of
dental caries in many developing countries were rising sharply.
Second, change is an equivocal, marked reduction in caries
experience among children and young adults in developed
countries.
But even in developed countries, there are distinct differences in
caries experience from one country to another and from region to
region within a country.

Decline in Dental Caries

The decline in dental caries was documented in countries with
national studies on dental caries.
The decline in dental caries was 32% between the first and second
survey in the US (1971-1974 to 1979-1980).
Also 36% decline was detected between the second and third
survey (1979-1980 to 1986-1987).
The decline has also been documented in primary teeth.
The caries decline in developed nations was documented at a
conference in Boston in 1982.
Data from 9 different countries all appointed to the same
conclusion, namely, that caries experience in children has
declined considerably over generation or so.
An important aspect of tooth decline is its effect on different tooth
surfaces.
In US study 81% of all new carious lesions were on occlusal
surfaces and pit and fissures of bucccal and lingual molar
surfaces.

Causes of Caries Decline

Fluoride exposure
Decrease consumption of sugar
Better oral hygiene
Changes in bacterial ecology of the oral cavity
Wide spread use of antibiotics

Distribution of Caries Severity

DMF index is an index to measure the distribution of dental caries
in a group of people, society, or nations.
The phrase DMF is composed of D = decay, M = Missing of teeth
due to caries, and F = filling of carious tooth.
There is no generally acceptable definition of severe caries.
However, DMF value of 7 or more considered severe caries in
children.
In US children up to age 17, there were 27.3% of children have
severe caries (DMF>=7) in 1979-1980 survey.
This has dropped to 17% in the 1986-1987 survey.
In distributing the frequency of DMF among different type of people
we will find that 50% of all affected teeth are found in about 12%
of children, and over 75% of all affected teeth are in less than
25% of children.
This concentration of disease in relatively few children had led to
the concept of targeting public health prevention programs
toward that highly affected minority.
And has stimulated research into methods of predicting which
children are likely to be found in the 20% or so most affected.

Determinants and Risk Factors for Dental Caries

Age:
Mean DMF increases with age.
In the childhood there is high caries rate and in elderly there is high
percentage of missing due to caries.
However, new research demonstrated that carious attack is likely
to spread out more through out life, and there is evidence that
older adults can develop new carious lesions.

Sex:
Females generally demonstrate higher DMF scores than do males,
although this finding is not universal.
The difference is small enough to be explained by earlier eruption
of teeth in females, their teeth at risk in oral environment for
longer time.
Females visit the dentist more frequently, so treatment factor could
be influencing the DMF data observed.
Probably a combination of earlier tooth eruption plus a treatment
factor explains the observed differences in DMF values between
males and females.

Race and Ethnicity:

Contentions that certain races enjoy a high degree of resistance to
dental caries have been around for a long time.
These assertions have faded as the evidence mounts that global
differences in caries experience are more a result of environment
than they are of inherent racial attributes.
The overall pattern that emerges from data from different studies is
that there is no basis for believing in inherent difference between
races and ethnicity.
Socioeconomic differences, which means differences in education,
self-care, attitude, values, available income, and access to health
care, appear to be far more important determinant.

Socioeconomic status:
Socioeconomic status (SES) is a broad measure of an individual’s
background in terms of such factors as education, income,
occupation, attitudes and values.
SES is a valuable measure in many health studies because it is
also closely correlated with many health-related characteristics.
In many studies differences in caries experience were found
between children in the higher and lower social classes.

Familial and genetic patterns:

Familial tendencies are seen by many dentists and have been
demonstrated by research.
However, these studies do not pin down wither such tendencies
have any genetic basis or weather they only represent bacterial
transmission or continuing familial dietary or behavioral traits.
Husband-wife similarities clearly have no genetic origin, and
intrafamilial transmission of cariogenic bacteria has also been
shown to occur.