Dental caries. Determination.

Epidemiology of
caries: prevalence and intensity of caries,
increase of intensity. Card of epidemiology
examination of WHO. Etiology and cariogenesis.
Modern pictures of reasons of origin and theory
of development of caries: essence, advantages
and failings. Concept of functionally structural
resistence of hard tissues of tooth.
Lecturer: as. Yavors’ka-Skrabut I.M.
Therapeutic dentistry department

Medical University of South Carolina/SC-Geriatric Education Center

The Epidemiology of
Dental Caries in
Older Adults

Medical University of South Carolina/SC-Geriatric Education Center

Overview
 Epidemiology

 Epidemiology of dental caries

 Definition
 Distribution
 By geography, age, gender, race/ethnicity, SES
 Determinants
 Food cariogenicity, diet

 Studies of dental caries in older adults

 Conclusions
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Learning Objectives
At the conclusion of this module, the
participant will be able to:
 Define epidemiology
 Define dental caries
 Describe the dental caries index
 Describe the epidemiology of dental
caries
 Describe factors related to dental caries

Medical University of South Carolina/SC-Geriatric Education Center

Supplemental Documents
The Pre-Post Test Question with
answers, References, and Evaluation
Form for this module are found on a
separate MS Word document.

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Epidemiology1
Epidemiology is the study of the
 Distribution and
 Determinants of
 Disease/health in a population

Definition mnemonic – “3D’s”

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 Disease: Dental Caries2-4
 How to define dental caries?
 Demineralization of the hard tissues of the
teeth caused by low pH, e.g., bacterial acids
 http://oralhealth.dent.umich.edu/CDRAM/Princi
ples.

 How to measure dental caries?

 DMFT and DMFS
 http://www.whocollab.od.mah.se/expl/orhdmft.
html
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 Human Teeth with Dental Caries
Dental enamel caries

Photo courtesy of DW Sneed, DMD, MAT

Dental enamel demineralization
MUSC College of Dental Medicine
Medical University of South Carolina/SC-Geriatric Education Center
 Close-up Photograph of Root Caries
Dental enamel

Root
surface

Photo courtesy of DW Sneed, DMD, MAT

Root caries MUSC College of Dental Medicine
Medical University of South Carolina/SC-Geriatric Education Center
 Disease: Dental Caries5-8
 How to count dental caries for a
population?
U.S. National Surveys
 NHANES, HHANES, NOHSS
http://www.cdc.gov/nchs/nhanes.htm
http://www.cdc.gov/nohss/sealants/surveys.htm

 NIDCR/CDC Dental, Oral, and Craniofacial Data

Resource Center
http://drc.nidcr.nih.gov/default.htm

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 A Brief History of Dental Caries9
 Evidence from human skulls
 400’s – 1500’s
 occlusal dental caries relatively uncommon
 attrition outpaced occlusal caries
 root caries predominate

 1600’s – 1800’s
 more refined foods, sugar
 new dental caries pattern
 generally begin in pits & fissures of teeth
 later on proximal surfaces (between teeth)
 well-established by end of 1800’s in most developed
countries

Medical University of South Carolina/SC-Geriatric Education Center

Brief History of Dental Caries9
 Throughout most of 1900’s
 Dental caries experience
 seen primarily in high-income countries
 low prevalence in low-income world
 likely related to diet

 Late 1900’s
 Dental caries experience
 increase in some (not all) low-income countries
 decrease in high-income countries among
 children
 young adults
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Distribution: Dental
Caries

 Geographic
 Age
 Gender
 Race / ethnicity
 Socioeconomic status
 Familial patterns

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 Distribution: Geographic10
By Country
http://www.whocollab.od.mah.se/countriesalphab.html
#Top
Variation among countries

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Distribution: Geographic

 By Region in the US:

 Variation within country
 DMFS generally
 highest in Northeast, lowest in West, and
 intermediate in Midwest and South
 less distinct differences today than 50 years
ago
 impact of fluorides and water fluoridation

Medical University of South Carolina/SC-Geriatric Education Center

 Distribution: Age

 DMF scores increase with increasing age

 DMF index is cumulative
 (Decayed can become Filled, and then Missing
through time)
 Whole tooth missing due to dental caries is
equal to a count of 4 or 5 surfaces in the
DMFS index
 Cohort effect

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Average Number of Dental Caries on Permanent
Teeth Surfaces (DMF),
Among Dentate Persons by Age11

90
80
70
Mean DMFS

60
50
40
30
20
10
0
'18-19 '20-29 '30-39 '40-49 '50-59 '60-69 '70+
Age

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Average Number of Root Caries Surfaces
(Decayed or Filled) on Permanent Teeth Among
Dentate Persons by Age11

2.5
Root Caries

1.5

0.5

0
'18-19 '20-29 '30-39 '40-49 '50-59 '60-69 '70+
Age

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Distribution: Gender

 Females generally have higher DMF

scores
 Probable treatment effect
 females usually have higher “Filled”
component
 Earlier tooth eruption among females
 Cannot say females are more
susceptible to dental caries

Medical University of South Carolina/SC-Geriatric Education Center

Average Number of Coronal Caries on Permanent Teeth
Surfaces, DMF, Among Dentate Persons by Gender and
by Age11

90
80
70
Mean DMFS

60
50
40
30
20
10
0
'Male

'Male

'Male

'Male

'Male

'Male

'Male
'Female

'Female

'Female

'Female

'Female

'Female

'Female
'18- '18- '20- '20- '30- '30- '40- '40- '50- '50- '60- '60- '70+ '70+
19 19 29 29 39 39 49 49 59 59 69 69
Age (years) by Gender

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Distribution: Race-Ethnicity
 Little evidence for inherent differences in
dental caries susceptibility across race-
ethnicity.

 Differences in socioeconomic status associated

with race-ethnicity in the U.S. are probably
more important.

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Distribution: Socioeconomic Status

 SES relates to a person’s background-

values
 Education
 Income
 Occupation

 Most recent data suggest that DMFS

scores are inversely related to SES

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 Average DMFS Scores for Adults in Three
9,11
Average DMFS
Socioeconomic Levels, 1988-949,11
80
Decayed
70 Missing
60 Filled
50
40
30
20
10
0
Low Middle High Low Middle High Low Middle High

15-24 years 35-44 years 55-64 years

Socioeconomic Status and Age Groups

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Percentage of adults aged 50 years and older
with 21 or more teeth by race-ethnicity and
federal poverty level10,11

• Age standardized to the year 2000 U.S. population.

Medical University of South Carolina/SC-Geriatric Education Center 4.2.3

Distribution : Familial Patterns9
 “My family has bad teeth”

May be a function of
 Bacterial transmission
 Family habits/ culture
 diet
 behavioral traits
 Genetics (e.g., salivary flow, composition)

 Additional research is needed

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Determinants: Dental
Caries
 Host (teeth)
 Substrate (fermentable
carbohydrates)
 Flora (bacteria)
 Time

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 Determinants: Cariogenicity12
 ‘Cariogenicity’ is suggested to apply to gram-
to-gram cariogenic potential for comparisons

 ‘Effective cariogenicity’ includes both the

gram-to-gram cariogenic potential and the
frequency and duration of exposure of the
teeth

 Fruits, in general, have very low or no

cariogenic potential.

Medical University of South Carolina/SC-Geriatric Education Center

Determinants: Diet & Dental Caries9

 The intake of refined carbohydrates,

especially refined sugars, is a risk factor for
caries,
e.g.,
 animal models
 human studies

 Cooked or milled starches can be broken

down by salivary amylase and then serve as
a substrate for cariogenic bacteria
 Uncooked / lightly cooked vegetables are
considered virtually noncariogenic

Medical University of South Carolina/SC-Geriatric Education Center

Dental Caries Experience in
Older Adults13

 Four large cohort studies of adults

aged 50 years or older
 Iowa
 North Carolina
 Ontario
 South Australia

 Reports of coronal and root caries

 At least a 3 year follow-up period

Medical University of South Carolina/SC-Geriatric Education Center

Incidence and Increments of Coronal and
Root Caries in Older Adults13
Number at Observation Coronal Caries Root Surface Caries Both
follow-up period Combined
(years)
Study Incidence Increment Incidence Increment Increment

Iowa 338 3 56% 2.4 (0.8)* 44% 1.1 (0.4) 3.5 (1.2)

North 3
Carolina

Blacks 234 45% 1.6 (0.5) 29% 0.6 (0.2) 2.2 (0.7)

Whites 218 59% 2.1 (0.7) 39% 0.8 (0.3) 2.9 (1.0)

Ontario 493 3 57% 1.9 (0.6) 27% 0.6 (0.2) 2.5 (0.8)

South 528 5 67% 2.7 (0.5) 59% 2.2 (0.4) 4.9 (1.0)
Australia

•Parentheses contain the annualized increment, computed by dividing the combined caries increment by the number of years of
follow-up, then rounding the result to 1 decimal place
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Risk Factors for Caries Development
in Older Adults13

 Coronal caries
 No common risk factors
 Suggested factors include low SES, and severity
of periodontal attachment loss at baseline

 Root caries
 Common risk factor was partial denture wearing
 Other suggested factors include periodontal
problems and age

Medical University of South Carolina/SC-Geriatric Education Center

Caries in Swedish Older
Adults14

 Methods
 10-year incidence study
 55, 65, and 75 years old at baseline
 Measured coronal and root caries

 Results
 Higher incidence of coronal caries in youngest
age group (65 years old at conclusion of study)
 Higher incidence of root caries in oldest age
group (85 years old at conclusion of study)

Medical University of South Carolina/SC-Geriatric Education Center

A State of Decay: The Oral Health of
Older Americans15
 September 2003: publication of an Oral Health America
Special Grading Project

 http://www.oralhealthamerica.org/pdf/StateofDecayFinal.pd
f

 Overall National Grade: D

 Vast majority of older Americans do not have dental

insurance coverage
 No Medicare dental coverage
 Most state Medicaid programs only cover emergency-only
dental benefits: D+
 71-80% do not have private dental insurance: D

Medical University of South Carolina/SC-Geriatric Education Center

 Conclusions
 As the number of missing teeth increase with
increased age, so do the number of surfaces
affected by dental caries

 Older adults suffer from the accumulation of

coronal and root caries over their lifetimes

 Older adults have less dental insurance (Medicare

does not cover usual dental services), make fewer
dental visits, and use more medication that may
lead to decreased saliva (xerostomia)

Medical University of South Carolina/SC-Geriatric Education Center

Biography
Susan G. Reed, DDS, MPH, DrPH is an Assistant
Professor of Stomatology, Director of the Dental Public
Health & Oral Epidemiology Section at the College of
Dental Medicine. Her joint appointment is with the
Department of Biometry, Bioinformatics &
Epidemiology. Her dental degree is from Case Western
Reserve University and she is a 1996 graduate of the
University of Michigan, School of Public Health where
she completed her MPH, Residency in Dental Public
Health, and was an NIH fellow for her doctorate in
oral epidemiology. Dr. Reed is Board Certified in
Dental Public Health. Her research interests include
the epidemiology of oral cancer in SC, and oral
Chlamydia trachomatis research.

Medical University of South Carolina/SC-Geriatric Education Center