dental caries and root caries risk assesment

caries

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

2. Contents
Introduction1
Caries risk assessment2
Caries prevention3
Conclusion4

3. WHO, 2002

4. UN, 2001

7. WHO, 2002

8. Active Ageing
HealthHealth
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
ParticipationParticipation
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
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

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

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

11. WHO, 2002

12. Oral Health Problem in Elderly
Tooth loss1
Denture related condition2
Coronal and root caries3
Periodontal disease4
Xerostomia5
Cancer and precancer6
Petersen & Yamamoto, 2005

13. 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

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

15. Company Logo
Identify Risk FactorIdentify Risk Factor
Dental Caries
DistributionDistribution
DiagnosisDiagnosis
PatternPattern PrevalencePrevalence

16. 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

17. 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

19. 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

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

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

22. Microbial
Colonization
Caries Experience
Behavior
SES,
Oral Hygiene,
Diet
Saliva

23. Petersen, 2005

24. 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

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

26. Tooth
Substrate
Microorganism
Keyes’s diagram

27. Moynihan & Petersen, 2004

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)

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

30. Vipeholm Study
Control group
Sucrose group
Bread group
Chocolate group
Caramel group
8 toffee group
24 toffee group

31. The Vipeholm
Study

32. The Vipeholm
Study

33. 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

34. Stephan’s Curve

35. Saliva
Microbial
Colonization Caries
Experience
Behavior
SES,
Oral Hygiene,
Diet

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

37. SES,
Oral Hygiene,
Diet
Saliva
Microbial
Colonization
Caries
Experience
Behavior

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

39. Miravet et al., 2007

40. Motohashi et al., 2006

41. Behavior
SES,
Oral Hygiene,
Diet
Saliva
Microbial
Colonization
Caries
Experience

42. 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.

43. Scheie et al,
1996

44. Van Houte, 1993

45. Van Houte, 1993

46. 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

47. Caries
Experience
Behavior
SES,
Oral Hygiene,
Diet
Saliva
Microbial
Colonization

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

49. Lenander-Lumikari & Loimaranta, 2000

50. Xerostomia
subjective 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, 2008

51. Lenander-Lumikari & Loimaranta, 2000
Buffer Capacity

52. Klienberg et al., 1973
Flow Rate

53. Commercial kits for saliva and microbial test

59. Resazurin Disc (RD) test

67. Other commercial kits
Caries Screen
Proflow
Oricult
Mucount

68. Consideration for Root Caries
11
Older people are a caries-active group,
experiencing new disease at a rate
which is as great as that of adolescents
22
The risk factor common to all studies
about root caries was the wearing of a
partial denture.
Thompson, 2004

69. Unit : surface

72. Saunders & Meyerowitz, 2005

73. Putting them together

74. Fejerskov & Manji 1990

75. Cariogram

76. Miravet et al., 2007

77. 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, 2004

78. Reduce the pathogenic potential of dental plaque
Mechanical plaque control1
Chemotherapeutic method2
Food intake restriction3
Replacement sweetener4
Sugar frequency reduction 5

79. Augment salivary factors
Sugar free chewing gum1
Supportive life style2
Elevate salivary quality3
Increase saliva mineralization4
Enhance F in saliva 5

80. Increase tooth structure resistance to caries attack
Community fluoride program1
Professional fluoride2
Self application fluoride3
Sealant4
Enamel treatment 5

81. Mode of ActionMode of Action
BactericideBactericide
CrystallizeCrystallize
RemineralizeRemineralize