Dental Caries and Root Caries

Risk Assessment and

Prevention

Narumanas Korwanich
Department of Community Dentistry
Chiangmai University
 Contents

1 Introduction

2 Caries risk assessment

3 Caries prevention

4 Conclusion
WHO,
WHO,2002
2002
UN,
UN,2001
2001
WHO,
WHO,2002
2002
 Active Ageing

When the risk factors for chronic diseases and functional

Health decline are kept low while the protective factors are kept
high, people will enjoy both a longer quantity and quality of
life

When labor market, employment, education, health and

Participation 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

When policies and program address the social, financial and

physical security needs and rights of people as they age,
Security 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
Petersen&&Yamamoto,
Yamamoto,2005
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,
WHO,2002
2002
Oral Health Problem in Elderly

1 Tooth loss

2 Denture related condition

3 Coronal and root caries

4 Periodontal disease

5 Xerostomia

6 Cancer and precancer

Petersen
Petersen&&Yamamoto,
Yamamoto,2005
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,
NIH,2001
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
Fontanaand
andZero,
Zero,2006
2006
 Identify
Identify Risk
Risk Factor
Factor

Dental Caries

Distribution Pattern Prevalence Diagnosis

Company Logo
 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,
Beck,1996
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 Prediction Prediction Prediction

based on based on based on based on
socio- behavioral past caries salivary
economic factors experience factors and
status, microbial
oral hygiene colonization
and dietary
factors

Messer,
Messer,2000
2000
 Caries Experience
Behavior

Microbial
Colonization SES,
Oral Hygiene,
Diet
Saliva
Petersen,
Petersen,2005
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
NIH2002
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 Microorganism

Substrate

Keyes’s diagram
Moynihan
Moynihan&&Petersen,
Petersen,2004
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

 1945-1953
 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
 Vipeholm Study

 Control group
 Sucrose group
 Bread group
 Chocolate group
 Caramel group
 8 toffee group
 24 toffee group
The Vipeholm
Study
The Vipeholm
Study
 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
Stephan’s Curve
 Microbial
Colonization Caries
Experience

Saliva
Behavior

SES,
Oral Hygiene,
Diet
 Age  Breast feeding
 Nocturnal bottle usage  Bottle feeding
 Additive  Regularity of snacks
 On pacifier during  Drinking sweet
sleep beverage
 Breast feeding  Watching television
during meal
 Brushing by mother

Ho and Messer, 1993 Kawabata et al., 1997

 Saliva
Microbial
Colonization

SES,
Oral Hygiene, Caries
Diet Experience
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
Miravetetetal.,
al.,2007
2007
Motohashi
Motohashietetal.,
al.,2006
2006
 SES,
Oral Hygiene, Saliva
Diet

Behavior
Microbial
Colonization
Caries
Experience
 Ecological Plaque

Mutan streptococci Other oral bacteria

are sufficiently
Lactobacilli Innoculation of acidogenic.
S.mutans shows Adherence of
Association of
higher caries plaque without
Lactobacilli and
activity. mutan
dental caries.
High acid streptococci.
Association of
production activity
Lactobacilli and
of S.mutans
fermentable
carbohydrates.
Scheie et al,
1996
Van
VanHoute,
Houte,1993
1993
Van
VanHoute,
Houte,1993
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
VanHoute,
Houte,1993
1993
 Behavior
SES,
Oral Hygiene,
Diet
Caries
Experience Saliva

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

Dodd et al., 2005

Lenander-Lumikari
Lenander-Lumikari&&Loimaranta,
Loimaranta,2000
2000
 Salivary Flow Rate

Xerostomia Hyposalivation
subjective report of Objective salivary flow
oral dryness related to rate that is under 0.1 or
gender 0.16 ml/min (or 0.1
ml/min; relate to
medication and
systemic disease

Tanathipanont
Tanathipanont&&Korwanich,
Korwanich,2008
2008
Buffer Capacity

Lenander-Lumikari
Lenander-Lumikari&&Loimaranta,
Loimaranta,2000
2000
Flow Rate

Klienberg
Klienbergetetal.,
al.,1973
1973
Commercial
Commercialkits
kitsfor
forsaliva
salivaand
andmicrobial
microbialtest
test
Resazurin
Resazurin Disc
Disc (RD)
(RD) test
test
 Other commercial kits

 Caries Screen
 Proflow
 Oricult
 Mucount
Consideration for Root Caries

Older people are a caries-active group,

1 experiencing new disease at a rate
which is as great as that of adolescents

The risk factor common to all studies

2 about root caries was the wearing of a
partial denture.

Thompson,
Thompson,2004
2004
Unit
Unit: :surface
surface
Saunders
Saunders&&Meyerowitz,
Meyerowitz,2005
2005
Putting
Putting them
them together
together
Fejerskov
Fejerskov&&Manji
Manji1990
1990
Cariogram
Cariogram
Miravet
Miravetetetal.,
al.,2007
2007
 Caries Prevention

1 2 3

Reduce the Increase the Augment

pathogenic resistance of salivary
potential of tooth factors
dental plaque structure to
caries attack

Walsh,
Walsh,2004
2004
Reduce the pathogenic potential of dental plaque

1 Mechanical plaque control

2 Chemotherapeutic method

3 Food intake restriction

4 Replacement sweetener

5 Sugar frequency reduction

 Augment salivary factors

1 Sugar free chewing gum

2 Supportive life style

3 Elevate salivary quality

4 Increase saliva mineralization

5 Enhance F in saliva
Increase tooth structure resistance to caries attack

1 Community fluoride program

2 Professional fluoride

3 Self application fluoride

4 Sealant

5 Enamel treatment
 Bactericide

Mode of Action
Crystallize

Remineralize