Lecturer: as. Yavors’ka-Skrabut I.M. Therapeutic dentistry department

1. 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

2. The Epidemiology of Dental Caries in Older Adults

3. 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

4. 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

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

6. Epidemiology1 Epidemiology is the study of the • Distribution and • Determinants of • Disease/health in a population Definition mnemonic – “3D’s”

7. 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/Principles. • How to measure dental caries? • DMFT and DMFS • http://www.whocollab.od.mah.se/expl/orhdmft.html

8. Dental enamel caries Dental enamel demineralization Human Teeth with Dental Caries Photo courtesy of DW Sneed, DMD, MAT MUSC College of Dental Medicine

9. Close-up Photograph of Root Caries Dental enamel Root surface Root caries Photo courtesy of DW Sneed, DMD, MAT MUSC College of Dental Medicine

10. 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

11. 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

12. 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

13. Distribution: Dental Caries • Geographic • Age • Gender • Race / ethnicity • Socioeconomic status • Familial patterns

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

15. 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

16. 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

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

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

19. 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

20. Average Number of Coronal Caries on Permanent Teeth Surfaces, DMF, Among Dentate Persons by Gender and by Age11 Age (years) by Gender

21. 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.

22. 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

23. 9,11 15-24 years 35-44 years 55-64 years Socioeconomic Status and Age Groups

24. 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. 4.2.3

25. 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

26. Determinants: Dental Caries • Host (teeth) • Substrate (fermentable carbohydrates) • Flora (bacteria) • Time

27. 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.

28. 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

29. 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

30. Incidence and Increments of Coronal and Root Caries in Older Adults13 • 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

31. 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

32. 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)

33. 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.pdf • 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

34. 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)

35. 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.