Dental caries-epidemiological studies

(international and indian studies)

Studies On:

Prevalence
Incidence
Contributing factors
origin
Epidemia-prevalence of disease

Logos -study
Definition- branch of medicine which deals with the
incidence, distribution and possible control of diseases
and other factors relating to health
the science concerned with the study of the factors
determining and influencing the frequency and
distribution of disease, injury, and other health-related
events and their causes in a defined human population.
Also, the sum of knowledge gained in such a study
Clark-1965-

science concerned with the study of factors that

influence the occurrence and distribution of health,
disease and defects ,disability or death in a group of
individuals.
 Epidemiology is the study of distribution and determinants of disease and
health related events in human population with a review to ensure that the
health services are planned rationally, disease surveillance is effected and that
preventive and control measures are undertaken.
challenge
 Signs of disease may be found on many different sites

 Caries exhibit a wide range of clinical features

 Early lesions are hard to detect

 (Morelli, 1924)

 It was not until Bodecker(1939) and Klein and Palmer (1940) more
exactly defined the pattern of attack by dental caries that epidemiologic
methods of assessment became better standardized and more widely
useful.
incidence
 Incidence is a measure of the risk of developing some new
condition within a specified period of time

Prevalence:

Point Prevalence-frequency of a disease in a given population at a given

point of time

Period Prevalence-frequency of current cases during a defined period of

time
Prevalence of caries
 In a cross sectional examination of 10 and 11 years olds in southern
Italy, a significant difference was found between the young boys and
girls.

 The mean DFT for boys was 3.20 versus a mean DFT of 1.96 in girls.

 D. Migale, E. Barbato, M. Bossu, R. Ferro, and L. Ottolenghi, “Oral health and

malocclusion in 10-to-11 years-old children in southern Italy,” European Journal of
Paediatric Dentistry, vol. 10, no. 1, pp. 13–18, 2009.
 window of time where prevalence switches from male to female.

 The study population was limited to 5 and 12 year old children (1009, 5-year-olds and 1013, 12
year olds). In the 5 year old age group,

 S. Saravanan, K. P. Anuradha, and D. J. Bhaskar, “Prevalence of dental caries and treatment needs
among school going children of Pondicherry, India,” Journal of the Indian Society of Pedodontics and
Preventive Dentistry, vol. 21, no. 1, pp. 1–12, 2003. 
 

 Among the Guanches, females-8.8%

 boys - 4.5%

 1) earlier eruption of teeth in girls,

 2) easier access to food supplies by
women and frequent snacking during
food preparation
 3) pregnancy
 In india son preference, ritual fasting, and dietary restrictions during
pregnancy

 Genetic variation.

 Both biological (genetics, hormones, and reproductive history) and

anthropological (behavioral) factors such as culture-based division of labor and
gender-based dietary preferences play a role.

 Sex differences in dental caries experience: clinical evidence, complex etiology.

Lukacs JR.Clin Oral Investig. 2011 Oct;15(5)

 GENETIC
“caries susceptibility
amelogenin variant”
AMELY

AMELX

 K. Deeley, A. Letra, E. K. Rose,

et al., “Possible association of
amelogenin to high caries
experience in a Guatemalan-
A. Patir, F. Seymen, M. Yildirim,
Mayan population,” Caries
Research, vol. 42, no. 1, pp. 8–
et al., “Enamel formation genes
13, 2008 are associated with high caries
experience in Turkish
children,” Caries Research, vol.
42, no. 5, pp. 394–400, 2008. 
 <


 mean parotid salivary flow rate in females (0.45 

mL/min) was significantly lower than the mean parotid
salivary flow rate in males (0.59 mL/min P < .05

 R. S. Percival, S. J. Challacombe, and P. D. Marsh, “Flow rates of resting whole and stimulated
parotid saliva in relation to age and gender,” Journal of Dental Research, vol. 73, no. 8, pp.
1416–1420, 1994
  salivary flow rates from the buccal and labial glands in women were
lower than those in men, especially in the elderly participant

 IgA

 L. Eliasson, D. Birkhed, T. Osterberg, and A. Carlen, “Minor salivary

gland secretion rates and immunoglobulin A in adults and the
elderly,” European Journal of Oral Sciences, vol. 114, no. 6, pp. 494–
499, 2006.
 fluctuating hormone levels.
 biochemical composition of saliva
 saliva flow rate are modified in several important ways by
hormonal fluctuations during events such as puberty,
menstruation, and pregnancy,

 Explaining sex differences in dental caries prevalence: saliva, hormones, and "life-history" etiologies.
 Lukacs JR, Largaespada LLAm J Hum Biol. 2006 Jul-Aug;18(4):540-55.
 lack of putrefaction, a result of protein consumption, which contributes to the
formation of a less acidic oral environment

 A. A. Khan, S. K. Jain, and A. Shrivastav, “Prevalence of dental caries among the

population of Gwalior (India) in relation of different associated factors,” European
Journal of Dentistry, vol. 2, pp. 81–85, 2008.
Psychosocial and Economic Factors

 Women - lower level of literacy (35.5% versus 57.6% in

males)
- a lower sense of being loved and respected by their
family (7% versus 92% in males)

more women are single parents subject to the stress of care giving and also
at an economic disadvantage.

Women are more subject to domestic violence and eating disorders.

Systemic Correlations

high DMFT/DMFS scores and epilepsy

 I. Anjomshoaa, M. E. Cooper, and A. R. Vieira, “Caries is associated with
asthma and epilepsy,”European Journal of Dentistry, vol. 3, pp. 297–303, 2009.

pregnancy
 In general, the experience of pregnancy includes immune suppression,
cravings, hormonal fluctuations, salivary alterations, and other
physiological changes that would be expected to adversely affect the
host resistance to caries.
‘National Dental Epidemiology Programme for England, oral health survey of 5 year
old children 2012’ is the second national survey undertaken, the previous was in
2008.

 Four year trends show overall improvements in decay and its severity in young
children and the 2012 survey found:

overall tooth decay reduced from 30.9% to 27.9%

the proportion of children with untreated decay has reduced from 27.5% to 24.5%

children with sepsis in their mouths has reduced from 2.3% to 1.7% since 2008

72.1% of 5 year olds are free from tooth decay, up from 69.1% in 2008
 Sample population- 5171 children ages 5 months through 4
years
 6.4% caries, mean dmft score of
0.18.

 20% caries, with a mean dmft of 0.70.

 35% had caries, with a mean dmft of 1.35

 49% had caries, with a mean dmft of 2.36.



=3*

 lowest income category ----- score four times higher than those with caregivers in the
highest category.

 Children younger than age 3 had little evidence of dental treatment, and most of the children
with caries in each age group had no filled or extracted teeth

 Dental caries prevalence and treatment levels in Arizona preschool children.

 J M Tang, D S Altman, D C Robertson, D M O'Sullivan, J M Douglass, and N Tinanoff
739 children aged between 2.8 and 6.2 years; 620 children (84%) were caries free
at recruitment.
The incidence of developing a first carious (into dentine) lesion in caries free
children increased with age.
At age four the incidence of the first carious lesion was 9.5 per 100 person years
and at age seven it was 19.6 per 100 person years.
The tooth specific incidence of caries was found to be approximately 5-6 times
greater in children with caries at recruitment than in caries free children

K. M. Milsom1, A. S. Blinkhorn2 & M. Tickle3The incidence of dental caries in

the primary molar teeth of young children receiving National Health Service
funded dental care in practices in the North West of England
 The surveys published up to the sixties suggested that dental caries prevalence
was high in children of Western European countries. Children 12 years of age
often had on average more than 5 DMFT, and at the age of 15 the DMFT
averages were often above 10.

 Changes in Dental Caries 1953–2003T.M. MarthalerCaries Res 2004;38:173–

181
 ‘The average DMFT decreased steadily from 8 in 1965 to one in 1993’
[König, 2002].
 DENTAL CARIES STATUS IN 6-9 YEARS OLD CHILDREN SAEEDA ABDULLAH,HALIMA
SADIA QAZI, ANSER maxood
pakistan oral & dental journal vol 28, no. 1
Indian studies

Dental Caries in children below 5yrs

• Difficulty-cluster of samples
• uncooperative behaviour of children
• Difficulty in detailed examination of oral cavity
 Varied no.of teeth errupted
• no separate criteria developed
• Karnataka,WB, Chandigarh
• DC very low in 1st yr of life- 1% rural, 1.5% urban
• 3yrs- 13.2- 23%
• 5yrs – ½ affected

• Ashima et al – chandigarh —48% (1983)

• Kuriakose .S – kerala _ 57%
• -ve relation to socioeconomic status—
• -low socioeconomic status3.85------ high 1.95
5-6yrs
 89% Lucknow urban-Kavita et.al 1987 WHO
index(1983)

 24.7%-Abohar rural-Chopra et.al -1995 –WHO

index(1987
 Tewari.S- in Rohtak-
 113primary school children 5 years 36.3% , mean dmft
0.87
157 children aged 6 year-38.2% prevalence of dc
,mean dmft .91
Deciduous molars-were most affected by caries
prevalence of restored teeth-1.2%
3% children cleaned teeth once a day with tooth brush
and paste
 EASTERN REGION-MANDAL ETAL(1994)
Orissa,Sikkim-deft-2.36,2.5 in urban areas 1.48,1.59,70-rural
areas
 NORTH EASTERN HIGH PREVALENCE(SHARMA ETAL.

Meghalaya-deft-6.36,Manipur-5.53,Assam-5.35,Nagaland-6.40
 WESTERN INDIA
 5-6yrs-high caries prevalance
 Sehgal 1960 --- deft5.9, antia1962 -----deft 6.64
 Damle 1985--- deft-5.3
 SOUTHERN INDIA
Low --Gupta et al-deft-0.6,Bangalore ,Hyderabad-.83
high 2.10-Trivandrum(1999)

 Gopinath- chennai (1987) - 3-6yrs 36% mean dmft -1.36males 1.17

females
 Rathnakumari caries prevalance 67.5% -6yrs – 80children WHO 1997
criteria mean dmft 2.42
12yrs
NORTHERN INDIA
mean dmft 5.7, 1941, (shourie et al- Delhi )
• between 1977-83
chandigarh 3.4 Tewari-1977
Haryana 3.2-Damle-1982
 Punjab 3.9.Gauba-1983

• Chawla (1993)-1.2,Hariparkash-.86 ,1993, Narboo et

al(1998)-1.01,Singh AA(1999)- .79-average figures of
dc
EASTERN REGION

Static around 2
WESTERN INDIA

Early 60 ‘s – high
Sehgal (1960)– 5.6
Antia(1962) - 4.12

1993
Damle nagpur(4.1),mumbai(3.8)

1998
Still lower 1.23(damle)
SOUTHERN REGION

Tamil nadu – Shourie 1942 dmft-1.5

retmakumari (1997) –- 67.2%
Karnataka –puttur-59.76% (Goel .P) 12-13 yr old
 Kerala (India) the prevalence --- of dental caries was 68.5 percent.
 The highest caries - ten years age group (75.9 %)
 lowest (63 percent) in the eight years age
 The highest dmft score 2.73 was found in 9 yearsage group and
 highest DMFT score 2.06 was found in 12 years age group.

 Retnakumari Nprevalence of dental caries and risk assessment among primary school
children of 5-6yrs of age in the varkala muncipal srea of kerala Isppd dec 1999
1969
1993
1997
Epidemiology of Dental Caries in the World
Rafael da Silveira Moreira .(2 -7.8)
1977 to 2004WHO African Region (AFRO) 1.7 (±
1.3). 0.3 to 5.5.
1987 to 2008. WHO Region of the Americas (AMRO) 2.4 (±
1.4
1984 to 2008 WHO Region of South East Asia (SEARO)
0.50 to 3.94,
1973 to 2008 WHO European Region (EURO)
1987 to 2008 WHO Eastern Mediterranean Region (EMRO)
1984 to 2007 WHO Western Pacific Region (WPRO)
S shaped

 A Compilation of Epidemiologic Studies in Dental Caries

MAURY MASSLER; J. J. PINDBORG, Dr. Odont.;and CLIVE MOHAMMED OCTOBER 1954
AMERICAN JOURNAL OF PUBLIC HEALTH
In primary dentition
grid
Follows a growth trend since it is cumulative
Striking parallelism
Indian studies
 The prevalence of dental caries is approximately 60% - 65% in India

 Prevalence of Dental Caries among the Population of Gwalior (India) in

Relation of Different Associated Factors
 Abdul Arif Khana Sudhir K. Jainb Archana Shrivastava
 April 2008 - Vol.2 81 European Journal of Dentistry
Incidence of dental caries was higher in female.
High number of dental caries patients was
observed among vegetarian population.
21-30 year age group was found to be most
infected with dental caries
age group of 5, 8, 11 & 15 years respectively attending
schools in the city of cuttack, Orissa.
 The examination was carried out under natural light
and dental caries was diagnosed according to W.H.O.
Criteria 1983.
The point prevalence - 64.3%
average DMFT of 2. 38.
 Regarding treatment needs, 63.6% children required dental treatment
for various reason and it is in accordance with dental caries prevalence
of different age group.

 Prevalence of dental caries and treatment needs amongchildren of Cuttack

(Orissa). J Indian Soc Pedo Prev Dent December (2002) 20 (4) : 139-143 Dash
J.K.aSahoo P. K.b Bhuyan S.K.C Sahoo S.K.
 overall caries prevalence of 46.75% (DMFT 2.07) .
 5-7, 18.62%, 8-10- 49.23% and 11-14- 51.48%
 difference between 5-7 and 8-10 years-- highly significant, difference
8-10 and 11-14 years ---- not significant.
 difference between 5-7 and 11-14 years highly significant.
 The caries prevalence of boys was 48.13% (DMFT 2.19) and that of
girls was 45.26% (DMFT 1.94), and the difference was found to be
insignificant 

 Prevalence of dental caries and treatment needs in the school-going children of

rural areas in Udaipur districtYear : 2007  |  Volume : 25  |  Issue : 3  | V
Dhar, A Jain, TE Van Dyke, A Kohli
 assess the prevalencemof dental caries in school children in Chidambaram between 5-

15 age groups.

The study population consisted of 2362 children, 1258 were boys

and 1104 were girls.

 Prevalence Of Dental Caries, Socio-Economic status And Treatment Needs Among 5

To 15 Year Old School Going Children Of Chidambaram Joyson Moses, B N
Rangeeth, Deepa Gurunathan
5-8 years -group I
9-11 years - group II
12 – 15 years - group III
Out of 1068 children examined, 580 (54.3%) showed
evidence of dental caries


.
Prevalence of dental health problems among school going children in rural Kerala JOSE Aa ,
JOSEPH M Rb
 In 1967 Ernest Newbrun' described sucrose as the 'arch-criminal of dental caries

 Newbrun E. Sucrose, the archcriminal of dental caries.Odontol Revy 1967;18:373-86

 unique ability to support the synthesis of extracellular (water-soluble and
water-insoluble) glucans by mutans streptococci, enhancing its
accumulation in the plaque.

 virulence of glucan may have more to do with an alteration in plaque

ecology by increasing the porosity of plaque, permitting deeper penetration
of dietary sugars and greater acid production adjacent to the tooth surface 

 D. T. Zero, “Sugars—the arch criminal?” Caries Research, vol. 38, no. 3, pp.

277–285, 2004
 One study in Sweden involving a small number of preschool children found
that those consuming invert sugar (a mixture of glucose and fructose) in place
of sucrose had a lower caries increment in 2 years, although the differences did
not reach statistical significance 

 G. Frostell, D. Birkhed, S. Edwardsson et al., “Effect of partial substitution of invert sugar for sucrose
in combination with duraphat treatment on caries development in preschool children: the Malmo
study,” Caries Research, vol. 25, no. 4, pp. 304–310, 1991
 lactose (milk sugar) has been shown to be less acidogenic than other
sugars and less cariogenic, based on animal studies
 Guggenheim et aL found in rats inoculated with dextran-
producing streptococci that diets containing 25% glucose,
fructose, lactose or maltose caused significantly less caries
than 25% sucrose, and no more caries than did starch

 Cariogenicity of different dietary carbohydrates tested on rats in relative gnotobiosis with strepcoccus
producing mucopolysaccharide
 Helv odont acta 1996
Amount????????

Sugar consumption < 10mg/kg body wt---low caries

15mg/kg ----- high caries

 Role of diet and nutrition in the etiology and prevention of dental diseases
 Paul Moynihan,bulletin of World Health Organisation
 In the study no significant differences were found in children
consuming twice and three times the normal sugar ration when
compared with the control group

 King JD, Mellanby M, Stones HH, Green HN. The effect ofsugar
supplement on dental caries (MRC Report 288). London: HMSO, 1955
 Rugg-Gunn et al. (1984) conducted a longitudinal 2-year study on English adolescent
schoolchildren and demonstrated that the group who developed no caries ate daily a very
similar quantity of total sugars and confectionery in comparison with the group which
experienced most caries
Frequency
 Konig ----feeding machine.

 12 meals to 30 meals per day. The direct relationship between the

number of meals over which the diet was fed and the number of caries
lesions formed indicated the importance of frequency of consumption.

 animals consuming 12 grams of almost twice the standard diet -

showed fewer carious lesions than those consuming 6 grams over 30
meals.

 konig caries activity induced by frequency controlled feeding of diets

containing sucrose Arch of oral biology 1969
 Weiss & Trithart (1960) reported a direct and consistent relationship between
caries experience and the frequency of eating items of high sugar content or
high degree of adhesiveness between meals, by examining the dietary habits of
783 pre-schoolers in West Tennessee.

 eating no items between meals exhibited a def (caries indices for primary
dentition) of 3.3 teeth per child
 eating four or more such items between meals exhibited a def of 9.8 teeth per

child.

 SUGAR, SWEETENERS, MEAL FREQUENCY AND CARIES

Hopewood house study
 sugar supplement in the form of sticky toffees between
meals experienced higher caries increments when
compared with the non-sugar supplement control group,
the group eating its supplement in a soluble form and
the group eating its sugar in a sticky form at meal times
only.
 frequency of eating and the nature of the sugar-
containing food influenced cariogenicity
 Gustafsson BE, Quensel CE, Lanke LS, et al.
 The Vipeholm dental caries study. The effect of different levels of
carbohydrate intake on caries activity in 436 individuals observed for five
years. Acta Odontol Scand 1954;11:232-3
 'nature's toothbrush‘---'Sim Wallace
dictum‘

 y Slack and Martin in which they

provideda slice of firm crisp apple after
each meal and snack to children,
 and the negative findings of studies by
Averill and Averill
Sugar substitutes
 Intense sweeteners (non caloric)-aspartame, saccharin, sulfame,
glyyrrhizin
 Bulk sweetners(caloric) - sorbitol, xylitol and mannitol

 T. Ikeda, “Sugar substitutes: reasons and indications for theiruse,”

International Dental Journal, vol. 32, no. 1, pp. 33–43, 1982
 the subjects were assigned to 3 groups and provided with diets
containing sucrose, fructose and xylitol.

 Osmotic diahrroea,cost inability to be broken down

 Scheinin A, Makinen KK. Turku Sugar Studies I-XXI. Acta

Odontol Scand 1975;33 (Suppl 70):1-349
its role in the re-mineralization process;
its capacity to reduce the quantity of dental plaque
its ability to reduce the number of mutans streptococci
colonies
its influence on the pH of dental plaque and the buffer
capacity of saliva

 Sugar, alternative sweeteners and meal frequency in relation to caries prevention:

new perspectives
 BY DANIEL KANDELMAN
 The Belize study is the first clinical trial of xylitol that enables the caries-
preventive action of xylitol to be compared with sorbitol, and the results
indicate that xylitol is superior in reducing caries

 K. K. Makinen, C. A. Bennett, P. P. Hujoel et al., “Xylitol chewing ¨ gums and

caries rates: a 40-month cohort study,” Journal of Dental Research, vol. 74, no.
12, pp. 1904–1913, 1995
 molecular microbiological methods have shown that, even with a
sugar-rich diet, a much broader spectrum of acidogenic microbes is
found in dental plaque.
 simple sugars can be cariogenic, cooked starches are also now
recognised to be a caries threat, especially because such starches, while
not 'sticky in the hand', can be highly retentive in the mouth.
Metabolism of starch particles can yield a prolonged acidic challenge,
especially at retentive, caries-prone sites. These changes in the
paradigms of caries aetiology have important implications
for cariescontrol strategies.
 Preventing the transmission of S. mutans will likely be inadequate to
prevent caries if a sufficiently carbohydrate-rich diet continues. Similarly,
restriction of sucrose intake, although welcome, would be unlikely to be a
panacea for caries, especially if frequent starch intake persisted.
 Instead, approaches to optimise fluoride delivery, to target plaque
acidogenicity or acidogenic microbes, to promote plaque alkali generation, to
increase salivary flow or replace fermentable carbohydrates with non-
fermentable alternatives may be more promising

 Diet and the microbiology etiology of caries:new Paradigms

 By: Bradshaw, David J.; Lynch, Richard J. M. International Dental Journal. Dec2013 Supplement 2,
Vol. 63, p64-72
  EPS- helps colonisation of organisms
 They are highly protected against antimicrobials and are acidogenic as
well as acid tolerant
 The exopolysaccharide matrix: A virulence determinant of cariogenic biofilm
 H. Koo, M.L. Falsettaand M.I. Kleinj dent res 92(12):1065-1073, 2013

Osborn and colleagues that in certain communities where there is a high

carbohydrate intake the caries prevalence is low, have led to a search for
'protective factors‘ against caries.
  protective factor in cocoa

 Stralfors A. Inhibition of hamster caries by Cocoa. The effect of whole and

defatted cocoa, and the absence of activity in cocoa fat. Arch Oral Biol
1966;11: 617-26

The fruit juices labeled with “no added sugar” or “free from added sugar”,
contained substantial quantities of sugar and are equally cariogenic as are fruit
drinks with added sugar

Effect of commonly consumed sugar containing and sugar free fruit drinks on the hydrogen ion modulation of human
dental plaque
Nanika Mahajan, Bhanu Kotwal, Vinod Sachdev, Nivedita Rewa, Rakesh Gupta, Shefally GoyalJournal of Indian
Society of Pedodontics and Preventive Dentistry | Jan-Mar 2014 | Vol 32| Issue 1 |
 Murray 1991- fluoride therapy cornerstone in caries prevention

 Featherstone 1988 fluoride controls the initiation and prevention of

caries

 Topical fluoride (toothpastes, mouthrinses, gels or varnishes)

 for preventing dental caries in children and adolescents (Review) Marinho VCC, Higgins JPT, Logan

S, Sheiham A
 No significant relationship between caries experience of the
individual and fluoride content of the enamel.

 Furthermore, the fluoride content in surface enamel between teeth

developed in low and «optimal» fluoride areas is too small to explain
any significant effect on dissolution rate of the enamel.

 cariostatic effect of fluoride must therefore be sought in its local effect

on the oral environment, the possible effects on plaque colonization,
composition and metabolic activities are discussed.
cariostatic effect of water fluoridation, fluoride tooth paste and mouth rinses
can probably be ascribed to regular increases in fluoride ion activity in the oral
fluids.

the effect of high concentrations of topical fluoride solutions is thought to be a

result of a slow dissolution of calcium fluoride deposited in initial caries
lesions, whereby an increased fluoride ion concentration is maintained locally
for longer periods of time.

 Rational Use of Fluorides in Caries Prevention

A Concept Based on Possible Cariostatic Mechanisms1981, Vol. 39, No. 4 , Pages 241-249 Ole
Fejerskov1,2, Anders Thylstrup2 and Mogens Joost Larsen
 low pH more effective in caries model studies than neutral fluoride agents,

 due to the formation of a larger depot of calcium fluoride.

 Data from fluoridated areas indicate that the fluoride ion as such has a limited effect on
lesion development, and a major mechanism of the cariostatic effect may be reformation
of apatite (remineralization)

 effects of Fluoride on Caries Development and Progression in vivo.

   Authors:ØGAARD, B.1Source:Journal of Dental Research. Feb1990 Supplement, Vol. 69,

 There is evidence from the studies of Hadjimarkos in Oregon that
selenium is associated with higher caries levels,

 Anderson and his colleagues in the UK, Cadellm in New Zealand,

Curzon and Losee in the US, and Barmes in New Guinea that
molybdenum, strontium, boron, and lithium are associated individually
or in combination with lower caries prevalence
amount of sugar consumed,
the frequency of sugar intake
 the kind of sugars ingested have to be taken into consideration.
 overall nutrition, the number of meals and snacks per day, education
and motivation, fluoride (in tablets or drops, in mouthwashes,
toothpastes, baby foods, formulas, beverages, milk, vitamin
supplements and/or fluoridated water ingested), socioeconomic group,
ethnicity, oral hygiene status, use of preventive methods and
sweeteners other than sucrose are presented.
Role of Sugar and Sugar Substitutes in Dental Caries: A Review
Prahlad Gupta,Nidhi Gupta, Atish Prakash Pawar, Smita Shrishail
Birajdar, Amanpreet Singh Natt, and Harkanwal Preet Singh
Schachtele and Jensen
 (1) the effect of mixing foods prior to and during
ingestion
 (2) the sequence of eating different foods
 (3) the time when foods are eaten
 (4) the effect of changes in the form of the food
Streptococcus mutans

Colonisation increased by sucrose intake

 The Microbiology of Primary Dental Caries Jason M. Tanzer, D.M.D., Ph. D., Jill
Livingston, M.S., and Angela M. Thompson, B.S
 71% of the carious fissures had S. mutans accounting for more than
10% of the viable flora, whereas 70% of the fissures that were caries
free had no detectable S. mutans.
 Sixty-five percent of the pooled plaque samples from the children with
rampant caries had S. Mutans accounting for more than 10% of the
viable flora, whereas 40% of the pooled samples from children that
were caries free had no detectable S. mutans.
 Saliva samples tended to have low levels of S. mutans and were
equivocal in demonstrating a relationship between S. mutans and
caries.

 Association of Streptococcus mutans with Human Dental Decay W. J. Loesche  J.

Rowan L. H. Straffon P. J. Loos
 Although Streptococcus mutans has been implicated as a major etiological agent of
dental caries, the present cross-sectional preliminary study indicated that 10% of
subjects with caries in permanent teeth do not have detectable levels of S. mutans

 Bacteria of Dental Caries in Primary and Permanent Teeth in Children and Young
Adults
 Becker et al. compared the bacterial species found in early childhood
caries to those found in caries free children. Some species, such as
Streptococcus sanguinis, were associated with health, while others,
such as S. mutans, other Streptococcus spp., Veillonella spp.,
Actinomyces spp., Bifidobacterium spp., and Lactobacillus fermentum,
were associated with caries

 Becker, M. R., B. J. Paster, E. J. Leys, M. L. Moeschberger, S. G.

Kenyon,J. L. Galvin, S. K. Boches, F. E. Dewhirst, and A. L. Griffen.
2002. Molecular analysis of bacterial species associated with childhood
caries. J. Clin. Microbiol
 Munson et al. used cultural and molecular techniques to determine those
species associated with dental caries in adults.
 The authors demonstrated a diverse bacterial community, including S. mutans,
Lactobacillus spp., Rothia dentocariosa, and Propionibacterium spp.

 alcalescens in mixed continuous cultures. Arch. Oral Biol. 20:407–410. 29. Munson, M.
A., A. Banerjee, T. F. Watson, and W. G. Wade. 2004. Molecularanalysis of the microflora
associated with dental caries. J. Clin. Microbiol .
 16S rRNA gene sequencing was used for bacterial
community analysis. Streptococcus mutans was the
dominant species in many, but not all, subjects with
caries.
 Elevated levels of S. salivarius, S. sobrinus, and S.
parasanguinis.

 Beyond Streptococcus mutans: Dental Caries Onset Linked to Multiple

Species by 16S rRNA Community AnalysisErin L. Gross, Clifford J. Beall,
Stacey R. Kutsch, Noah D. Firestone,Eugene J. Leys, Ann L.
GriffenOctober 2012 | Volume 7 | Issue 10 | e47722
 Veillonella, which metabolizes lactate,

 including the Streptococcus mitis group, Neisseria, and Streptococcus

sanguinis. This may have implications for bacterial community resilience and
the restoration of oral health
A strong correlation has been established between the
saliva Lactobacillus count and dental caries, the higher the DMF index,
the higher the number of children harbouring a
high Lactobacillus count.
 Among children---lactobacilli -- coronal caries
 Among adults----lactobacilli ---root caries.
 most species belong to theLactobacillus casei group

 Ecology of Lactobacilli in the Oral Cavity: A Review of Literature C

Badet* and N.B Thebaud
actinomyces
 They have been implicated in root caries, although their role in dental
caries initiation and progression is not well-understood.

 Actinomyces. Of these, 242 were identified as A. israelii, 225 as A.

gerencseriae, 109 as A. naeslundii, 15 asA. odontolyticus, and 13 as A.
Georgiae

 The Predominant Actinomyces spp. Isolated from Infected Dentin of

Active Root Caries Lesions S.R. Brailsford jrnl of dental research
Morphology

Deep pits and fissures

Lingual pits
Prevalence of Dental Caries among the Population of Gwalior (India) in
Relation of Different Associated Factors
Abdul Arif Khana Sudhir K. Jainb Archana Shrivastava
April 2008 - Vol.2 81 European Journal of Dentistry
occlusal fissures on the first and second molars
contributed most significantly to caries frequency,
from 52.7% to 66.3%

 Prevalence of Caries on Individual Tooth Surfaces and its Distribution by Age and
Gender in University Clinic Patients
 Mustafa DemirciSafa Tuncer and Ahmet Ayhan Yuceoku caries research
 Composition

Surface more resistant to caries

Presence of trace elements like flouride and carbonate

Surface enamel is like a sponge

Changing Paradigms in Concepts on Dental Caries: Consequences for Oral
Health Care
O. Fejerskov
Relationship btw malocclusion and caries

 Prevalence of malocclusion and its relationship to caries among school children sged 11-
15yrs in southern india Jagan kumar et al Korean dental jrnl
 No relationship was found between the malocclusion traits and caries prevalence.

 Causal relation between malocclusion and caries 1989, Vol. 47, No. 4 , Pages 217-221

Sven Helm and Poul Erik Petersen


Malocclusion and caries prevalence: is there a connection in the primary and mixed
dentitions?
 Stahl F, Grabowski R Clin Oral Invest 2004 Jun;8(2):86-90. Epub 2003 Dec 23
Time for which food remains in the cavity
 Prolonged oral retention of foods leads to extended periods of acid
formation

 Thus, fermentable carbohydrate dietary items which are slowly

eliminated from the tooth surface are more cariogenic Consequently,
physical characteristics of food such as adhesiveness, solubility,
texture, and hardness are essential as they may affect the sugar oral
clearance and saliva flow
 that the rate of elimination of sugar is individual, highly related to the fluidity
and flowof saliva;
 (b) that the stickiness of food is not as important as the amount of carbohydrate
remaining in plaque and saliva because high initial retention can be followed
by rapid oral clearance;
 consequently, the level of cariogenicity of food should be mainly related to its
rate of clearance (Mundorff et at. 1990);
 (c) that white bread and raisins are retained a longer time than chocolate milk
or some sweets (Edgar et al. 1975; Kaskhet et al. 1991) and could produce a
higher sugar concentration,particularly when consumed between meals
(Lanke, 1957).

 Sugar, alternative sweeteners and meal frequency in relation to caries

prevention: new perspectives BY DANIEL KANDELMANBritish Journal
of Nutrition (1997), 77, Suppl.
conclusion
references
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DENTAL CARIES STATUS IN 6-9 YEARS OLD CHILDREN SAEEDA
ABDULLAH,HALIMA SADIA QAZI, ANSER maxood pakistan oral & dental