CS3-7. Epidemiology of Dental Caries - Prof. Dr. Ayşe Nil Altay.pdf

DTC 200 – KB 3 CARIES EPIDEMIOLOGY AND EARLY CHILDHOOD CARIES Prof. Dr.A.Nil Altay Learning Outcomes: 1. Will be able to list the properties of ECC 2. Will be able to describe the preventive treatment plan for ECC CARIES EPIDEMIOLOGY AND EARLY CHILDHHOOD CARIES The main features of the caries p...

DTC 200 – KB 3 CARIES EPIDEMIOLOGY AND EARLY CHILDHOOD CARIES Prof. Dr.A.Nil Altay Learning Outcomes: 1. Will be able to list the properties of ECC 2. Will be able to describe the preventive treatment plan for ECC CARIES EPIDEMIOLOGY AND EARLY CHILDHHOOD CARIES The main features of the caries process are: 1. 2. 3. 4. fermentation of carbohydrate to organic acids by micro-organisms rapid acid formation, which lowers the pH at the enamel surface the pH within plaque will rise due to the outward diffusion of acids dental caries progresses only when demineralization is greater than remineralization. One of the interesting features of an early carious lesion of the enamel is that the lesion is subsurface; that is, most of the mineral loss occurs beneath a relatively intact enamel surface. The layer of dental plaque on the tooth surface acting as a partial barrier to diffusion. Further erosion occurs at much lower pHs ( < 4) as dental caries. Dental plaque forms on uncleaned tooth surfaces if toothbrushing is stopped for 2-3 days.Plaque does not consist of food debris, but comprises 70% microorganisms⎯about 100 million organisms per milligram of plaque.Mutans streptococci much more numerous when the diet is rich in sugar and other carbohydrates, and these organisms are particularly good at metabolizing sugars to acids. Just to remember; Stephan curve is within 2-3 min of eating sugar, plaque pH falls from an average of about pH 6.8 to near pH 5, taking about 40 min to return to its original value. Below pH 5.5 demineralization of the enamel occurs, this is known as the critical pH. The clinical appearance of these early lesions is now well recognized. If the process of dental caries continues, support for the surface layer will become so weak that it will crumble like an eggshell, creating a cavity. The ability of early carious lesions ('precavitation carious lesions') to remineralize is now well understood; periods of demineralization are interspersed with periods of remineralization, and the outcome⎯health or disease⎯is the result of a push in one direction or the other on this dynamic equilibrium. The most important of the natural defences against dental caries is saliva. If salivary flow is impaired, dental caries can progress very rapidly Saliva not only physically removes dietary substrates and acids produced by plaque from the mouth, but it has a most important role in buffering the pH in saliva and within plaque. Fast-flowing saliva is alkaline⎯reaching pH values of 7.5-8.0⎯and is vitally important in raising the pH of dental plaque previously lowered by exposure to sugar and carbohydrates. Because teeth consist largely of calcium and phosphate, the concentration of calcium and phosphate in saliva and plaque is thought to be important in determining the progression or regression of caries. Key Points Dental caries: • occurs in plaque-covered areas frequently exposed to dietary carbohydrates; • the initial lesion is subsurface before the thin surface layer collapses; • the initial or pre-cavitation lesion is reversible; • saliva plays an essential part in caries prevention; • if all plaque is removed from the surface the carious process stops EPIDEMIOLOGY: Dental caries is one of our most prevalent diseases and yet there is considerable variation in its occurrence between countries, regions within countries, areas within regions, and social and ethnic groups. One of the tasks of epidemiology is to record the level of disease and the variation between groups. A second task is to record changes in the levels of dental caries in populations over time, while a third task is to try to explain these variations. Globally, an estimated 2 billion people suffer from caries of permanent teeth and 514 million children suffer from caries of primary teeth. 35 % 35-69 % > 70 % According to WHO 2020 ENDING CHILDHOOD DENTAL CARIES report primary care teams; • • • understand ECC as a public health problem; recognize the essential risk factors for ECC, which include non-exclusive breastfeeding, free sugars consumption, and inadequate exposure to fluoride to prevent dental caries; and identify opportunities to prevent ECC and combat its causes. An unacceptably large percentage of children, these teeth do not stay sound but are ravaged and sometimes totally destroyed by dental caries (dental decay). This is a preventable, global, noncommunicable disease (NCD) of medical, social and economic importance. Early childhood caries (ECC) differs from dental caries in older children and adults in its rapid development, its diversity of risk factors and its control. The aetiology and prevention of ECC are strongly determined by sociobehavioural, economic, environmental and societal factors, known as the social determinants of health. EARLY CHILDHOOD CARIES (ECC) is characterized by the presence of one or more teeth affected by carious lesions or with white spot lesions in primary teeth, loss of teeth due to caries, or filled tooth surfaces in affected teeth of a child aged under six years. Consequences of ECC include a higher risk of pain or discomfort, abscesses, carious lesions in both the primary and permanent dentitions, risk for delayed physical growth and development, increased days with restricted activity, and diminished oral health-related quality of life. The aetiology is frequently linked with a high-frequent consumption of sugared drinks or food, lack of breastfeeding, and/or poor oral hygiene. Additionally, the disease often manifests in children from poor families or living in poor environmental settings. b a c f d e a. b. c. d. e. f. white spot lesion at upper primary insicors intact primary teeth at mandible arch cavitation at upper primary teeth cavitation at mandibular arch severe loss at hard tissues at maxilla root remants Early childhood caries (ECC) differs from dental caries in older children and adults in its rapid development, its diversity of risk factors and its control. RISK FACTORS: 1. 2. 3. 4. Transmission of Str Mutans from mother to baby Wrong feeding habits Lack of education Interaction of bacteria, tooth surface and sugary food 1.Transmission of Str Mutans from mother to baby: Infants acquire MS from their mothers only after the eruption of primary teeth. There is not MS in oral cavity before tooh eruption. Children acquire MS during a discrete period between the age of 19 and 33 months, designated as the ‘ first window of infectivity’, and the source of initial infection mostly is through mother. Transmission of MS: a) habit of kissing by mother b) sharing of the spoon with mother and family members c) cleaning the pacifier in mouth d) blowing into a spoon to cool the food 2.Wrong feeding habits: prolonged and nocturnal (night time) breastfeeding or bottle feeding is associated with an increased risk of ECC, especially after the age of 12 months. Breast milk has lactose in it. Breastfeeding should be finished in 1520 minutes. Prolonged feeding accumulates milk on teeth whole night which will cause to start the demineralization. Same way prolonged bottle feeding causes the ECC. In some culture parent/ caregiving prefer to dip pacifier to sugary contents to put the baby to sleep. 3. Lack of education: Parent / caregiving education, expected mother education, pediatrician education, neonatal nurses should be educated for feeding habits, cleaning/ brushing tooth and about damages of ECC. 4.Interaction of bacteria, tooth surface and sugary food : Dentists should be aware of preventing treatment plans for each individual. ECC causes many general health problems like reduced growth and reduced weight gain because of inability of eat due to discomfort and pain. Children's quality of life can be seriously affected because of pain and discomfort acute and chronic infections, a) b) c) d) altered eating and sleeping habits, risk of hospitalization, high treatment costs, and loss of school days with the consequent diminished ability to learn PREVENTION STRATEGIES AT ECC: 1. Decrease the transmisson of MS: a. Educate expected mother/ mother/ caregiving about transmisson b. Decrease the MS at expected mother/ mother/ caregiving via education and preventive / restorative treatment plans like; Clorhexidine mouthrinses, Treatment of all dental caries, Periodontal treatment and topical fluoride application ( home/ professional) c. To emphasize the importance of regular dental controls. 2. Preventive treatment plans for ECC child: a. Proper toothbrushing b. High fluoridated toothpaste usage c. Topical fluoride application d. CPP-ACP (Casein Phosphopeptide - Amorphous Calcium Phosphate) usage at home e. GIC restorations f. Fissure sealant application g. Fluoridated mouthwashes h. Dental floss usage Proper toothbrushing: Toothbrushing education differs according the age of children. Parents/ caregivings should take the responsibility of brushing teeth children up to 8 year-old. 8-12 year old children parents/caregiving shoul observe the brushing procedure. High fluoridated toothpaste usage: Children 0-6 year old should use 500 ppm fluoridated toothpaste.Dentist should advice “high fluoridated toothpaste” like 1000 ppm toothpaste to those children. 6-12 years old children should use 1000 ppm toothpaste in healthy conditions. With ECC it should be adviced as 1450-1500 ppm. Children above 12 year old with high caries risk should use 2400 ppm fluoridated toothpaste. Topical fluoride application: Topical fluoride application by dentist differs according to the risk group of children. Low caries risk group: topical fluoride is applied twice a year. High caries risk group: topicl fluoride is applied 4 times a year. CPP-ACP (Casein Phosphopeptide - Amorphous Calcium Phosphate) usage at home support the remineralization of enamel at ECC. GIC restorations: To desrease the MS in mouth before final restorations “stabilization” should be occured. After excavation smooth caries dentin with excavators GIC is placed to cavities. After stabilizing the oral health final restorations could be placed. Fissure sealant application: Dentist should plan the preventive strategies for future dentition.ECC children should be evaluated as “ high caries risk” group. For this purpose fissure sealants should be planned to permanent molars and premolars as soon as they erupt. Fluoridated mouthwashes: Children over 6 year old could use mouthwashes without risk. Dental floss: Dental floss education could be given to children over 8 year old. References: 1) McDonald and Avery’s ( 2016). Dentistry for the Child and Adolescent. 10th ed. Elsveir, Holland. 2) Welbury R, Duggal MS, Hosey MT ( 2018). Paediatric Dentistry. 5th Ed. Oxford, England. 3) WHO reports 4) F. Meyer, J. Enax . Early Childhood Caries: Epidemiology, Aetiology, and Prevention. Volume 18.