1. Narumanas Korwanich Department of Community Dentistry Chiangmai University Dental Caries and Root Caries Risk Assessment and Prevention

2. Contents Introduction 1 Caries risk assessment 2 Caries prevention 3 Conclusion 4

3. WHO, 2002

4. UN, 2001

7. WHO, 2002

8. Active Ageing Health When the risk factors for chronic diseases and functional decline are kept low while the protective factors are kept high, people will enjoy both a longer quantity and quality of life Participation When labor market, employment, education, health and 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 Security When policies and program address the social, financial and physical security needs and rights of people as they age, elderly are ensured of protection, dignity and care in the event that they are no longer able to support and protect themselves

9. 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 & Yamamoto, 2005

10. 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

11. WHO, 2002

12. Oral Health Problem in Elderly Tooth loss 1 Denture related condition 2 Coronal and root caries 3 Periodontal disease 4 Xerostomia 5 Cancer and precancer 6 Petersen & Yamamoto, 2005

13. 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, 2001

14. 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 and Zero, 2006

15. Company Logo Identify Risk Factor Dental Caries Distribution Diagnosis Pattern Prevalence

16. 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, 1996

17. 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

19. 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

20. 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

21. 1234 Prediction based on socio- economic status, oral hygiene and dietary factors Prediction based on behavioral factors Prediction based on past caries experience Prediction based on salivary factors and microbial colonization Messer, 2000

22. Microbial Colonization Caries Experience Behavior SES, Oral Hygiene, Diet Saliva

23. Petersen, 2005

24.  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 2002

25. Diet  Sugar exposure is important factor in caries development  Frequency and amount of sugar intake has been shown related to dental caries incidence

26. Tooth Substrate Microorganism Keyes’s diagram

27. Moynihan & Petersen, 2004

28.  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)

29. 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

30. Vipeholm Study  Control group  Sucrose group  Bread group  Chocolate group  Caramel group  8 toffee group  24 toffee group

31. The Vipeholm Study

33.  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

34. Stephan’s Curve

35. Saliva Microbial Colonization Caries Experience Behavior SES, Oral Hygiene, Diet

36.  Age  Nocturnal bottle usage  Additive  On pacifier during sleep  Breast feeding Ho and Messer, 1993  Breast feeding  Bottle feeding  Regularity of snacks  Drinking sweet beverage  Watching television during meal  Brushing by mother Kawabata et al., 1997

37. SES, Oral Hygiene, Diet Saliva Microbial Colonization Caries Experience Behavior

38.  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

39. Miravet et al., 2007

40. Motohashi et al., 2006

41. Behavior SES, Oral Hygiene, Diet Saliva Microbial Colonization Caries Experience

42. Mutan streptococci Ecological Plaque Lactobacilli Association of Lactobacilli and dental caries. Association of Lactobacilli and fermentable carbohydrates. Innoculation of S.mutans shows higher caries activity. High acid production activity of S.mutans Other oral bacteria are sufficiently acidogenic. Adherence of plaque without mutan streptococci.

43. Scheie et al, 1996

44. Van Houte, 1993

46.  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 Houte, 1993

47. Caries Experience Behavior SES, Oral Hygiene, Diet Saliva Microbial Colonization

48.  Saliva affects all three of components of Keyes’ classic Venn Diagram of caries etiology Dodd et al., 2005

49. Lenander-Lumikari & Loimaranta, 2000

50. Xerostomia subjective report of oral dryness related to gender Salivary Flow Rate Hyposalivation Objective salivary flow rate that is under 0.1 or 0.16 ml/min (or 0.1 ml/min; relate to medication and systemic disease Tanathipanont & Korwanich, 2008

51. Lenander-Lumikari & Loimaranta, 2000 Buffer Capacity

52. Klienberg et al., 1973 Flow Rate

53. Commercial kits for saliva and microbial test

59. Resazurin Disc (RD) test

67. Other commercial kits  Caries Screen  Proflow  Oricult  Mucount

68. Consideration for Root Caries 1 Older people are a caries-active group, experiencing new disease at a rate which is as great as that of adolescents 2 The risk factor common to all studies about root caries was the wearing of a partial denture. Thompson, 2004

69. Unit : surface

72. Saunders & Meyerowitz, 2005

73. Putting them together

74. Fejerskov & Manji 1990

75. Cariogram

76. Miravet et al., 2007

77. Caries Prevention 1 Reduce the pathogenic potential of dental plaque 2 Increase the resistance of tooth structure to caries attack 3 Augment salivary factors Walsh, 2004

78. Reduce the pathogenic potential of dental plaque Mechanical plaque control 1 Chemotherapeutic method 2 Food intake restriction 3 Replacement sweetener 4 Sugar frequency reduction 5

79. Augment salivary factors Sugar free chewing gum 1 Supportive life style 2 Elevate salivary quality 3 Increase saliva mineralization 4 Enhance F in saliva 5

80. Increase tooth structure resistance to caries attack Community fluoride program 1 Professional fluoride 2 Self application fluoride 3 Sealant 4 Enamel treatment 5

81. Mode of Action Bactericide Crystallize Remineralize