Dental caries, cause and preventive strategies in children.

By Dr. Nida LiaquatMSPH 2009-10

Dental caries:• Definition:

• It is a disease of microbial origin in which the dietary carbohydrates are fermented by the bacteria forming an acid which causes the

demineralization of the inorganic part and disintegration of the organic part of the tooth

Dental caries

• Dental caries is one of the most common of all disorders. • It usually occurs in children and young adults but can affect

any person.

• Plaque begins to build up on teeth within 20 minutes after eating.

• Dental plaque is a thin, tenacious microbial film that forms on the tooth surfaces and has colonies of bacteria.

Dental Epidemiology

• From the Australopithecines (over a million years ago) to the Neolithic (since 10,000 years ago), carious lesions have been found in almost every population study.

• In 1942, Authorities like Robert Robertson and his co workers carried out major break through was the relationship of dental caries and fluorides.

• Fluorides was an accidental discovery, which opened the doors of preventive dentistry.

• The evidence for trends in dental caries is especially interesting amongst North American Indians.

• When sugars have been introduced into the diet, fissure and proximal surface cavities, particularly in children, became dominant.

Etiology

• An interplay of three principal factors is responsible for this multifactorial disease.

• Thus, caries requires a susceptible host, cariogenic oral flora and a suitable substrate, which must be present for a sufficient length of time

Role of saliva

Global perspective:

• There has been remarkable progress in the reduction of tooth decay in the U.S. over the past 30 years. Nevertheless, dental caries continues to be a significant problem for many children.

• More than half of all children in the U.S. have dental caries by the second grade of school. By the age of 17, approximately 80% of young people have had a dental cavity.

• Water fluoridation in New Zealand reduces the risk of dental caries.• High risk children belong to low income families with poor parental

behaviors and attitudes.

DMFT index in Emro RegionEMRO

Country Year DMFT

Afghanistan 1991 2.9*

Iran Islamic republic 2001 1.8

2003 1.15

Morocco 1991 2.3

1999 2.5

Pakistan 1979 2.1

1988 1.2

1991 1.25

1999 0.9

2003 1.38

Saudi Arabia 1995 1.7

2002 5.9***

* 7-12 years

*** 12-14 years

In Pakistan

CARIES TRENDS

0

2

4

6

8

10

12 15 34-44

AGE IN YEARS

DM

FT

1999

2003

Fluoride analysis of drinking water

(1999-2000) (WHO) District Fluoride levels (ppm)

Karachi 0.1-0.14

Lahore 0.08-1.42

Rawal pindi 0.02-0.4

Multan 0.07-0.35

Peshawar 0.11-0.15

Quetta 0.86-1.11

Global policy for improvement of oral health in the 21st century – implications to oral

health research WHO 2007.

• For the first time in 25 years oral health was subject to discussion.

• Advances in oral health science have not yet benefited the poor and disadvantaged populations worldwide.

• The report provides a comprehensive analysis of the global burden of oral disease.

• Effective use of fluoride.• Action plan for promotion and integrated disease prevention.

• Oral health of children and youth through:• Health Promoting Schools• Healthy diet and nutrition

INTRODUCTION TO THE PROJECT FOR THE PREVENTION OF

DENTAL CARIES IN CHILDREN

Rationale

• It is important to increase the general awareness regarding oral health and more particularly for the economically disadvantaged portion of the child population.

• At a present time there are very few programs aiming at increasing the awareness regarding child’s oral health

• In dental offices there is little understanding if and in what capacity private practitioners could be involved in the implementation of such programs.

• Therefore, it is important for every dental practice to assess if and in what capacity they could be involved in reaching out to both the children and their parents and guiding them toward improved child’s oral health.

Aim

To reduce the prevalence of dental caries in children of Pakistan.

Objectives

• To measure the DMFT index of school going children between 6-12 years.

• To Assess their dietary habits.• To provide the oral health education to children, and

caregivers.

STRATEGIES FOR PREVENTING DENTAL CARIES

1. Establishment of children dental club.

2. Raising awareness and capacity building.

3. Seminars will be organized on oral education for the prevention of tooth decay.

4. Involvement of the policy makers regarding water fluoridation.

5. Multisectoral approach.

1. ESTABLISHMENT OF CHILDREN’S DENTAL CLUB

Children’s club has been specifically designed a program, including a reward\motivation

system that benefits the child and a somewhat of a counseling\guidance system that will frequently remind and help the caregiver

maintain the child’s oral health.

Children Dental Club Model

• Forms will be distributed to the children’s parents who are coming to clinics.

• Dental club recall patients every after 6 weeks, health promotion material are provided to them related risk factors involved.

• Parents are at the same time asked to answer two to three questions and mail them in the envelope provided.

• At the next recall visit if the child will present with healthy teeth he/she will earn the membership to “Dental Club”.

• The member child will be able to use this card to get Toys from the dental clinic.

• Dental Club membership and the health promotion letters, that are to be sent to the parents, are designed to increase the awareness regarding oral health and to award and motivate children and parents in achieving and maintaining oral health.

Dental club is a true investment in health and it will be a unique model for Pakistan.

2. Raising Awareness and Capacity building

Strategies

• Conduction of Health Education sessions.• Involving Mass media (TV, Radio, Dental pamphlets

and Newspapers)• Display of oral hygiene promotional material in the

schools.• Organize Dental camps in Schools.• Those children who diagnosed decayed will refer to the

dental club.• Training of Dental Professional regarding Promoting

oral hygiene.

3. ORGANIZING SEMINARS IN SCHOOLS

• Seminars will be organized in schools for the provision of oral health education among children. Parents will be invited too and dental gifts (toothpaste and tooth brush) will be distributed to the children.

• Documentary videos contain the oral health material will be shown too.

ORAL HEALTH EDUCATION

Oral health education regarding Caries prevention

1

Reduce the pathogenic potential of

dental plaque

2

Increase the resistance of

tooth structure to caries attack

3

Augment salivary factors

Plaque removal

• Tooth brushing

• Flossing

• Chemotherapeutic agents- e.g. Chlorhexidine- short term benefit

• Chewing gums- ADA approved

Diet Recommendations:

• Reduce sucrose consumption • Sweets are not to be eaten between meals or at

bedtime• Emphasize foods that require chewing, stay away

from soft/sticky foods• Brush teeth after meals and ALWAYS at Bedtime• Discuss the danger of “hidden” sugars such as

starchy foods (bread)

Fluoride Therapy

• Systemic Fluorides– Provided by water fluoridation.

• Water Fluoridation– Concentration of 1 ppm of fluorides in drinking

water is considered optimal in reducing caries prevalence

– Optimal fluoride concentration reduces caries up to 50%

Fluoride Therapy

• Topical Fluorides

– Delivered via gels, varnishes, mouth rinses and dentifrices.

– Commonly use topical fluorides sodium fluoride, hydrofluosilic acid and sodium silicofluoride

– No need for topical fluoride in patients with low risk and/or residing in optimally fluoridated areas- use of a fluoridated toothpaste should be sufficient.

– Fluoridated dentifrices are not recommended in small children (<3 years)

Toxicity by fluorides:

– Pea-sized amount.

– Dental fluorosis.

– Make sure child thoroughly expectorates toothpaste after brushing.

– Administer milk to slow absorption.

Augment salivary factors

• Sugar free chewing gums.

• Supportive life styles.

• Stop eating betel nuts.

Oral hygiene Instructions:

Oral hygiene is necessary to prevent cavities. This consists of regular professional cleaning (every 6 months), brushing at least twice a day, and flossing at least daily. X-rays may be

taken yearly to detect possible cavity development in high risk areas of the mouth.

4. Involvement of the policy makers:

• Ban/Restriction to the candy floss and toffees in school canteen.

• Ban/Restriction on eating candies in classes.

• Provision of fluoridated water in schools

5. Multisectoral approach

• Health Department• Education Deptt.• Private schools• NGOs• Dental clinics• Pharmaceuticals (Colgate, MacLean's etc.)

Evaluation

• No. of children include in dental club.• No. of their parents/caregivers involved.• No. of seminars conducted.• No. of sessions conducted.• No. of dental offices included.• No. of schools included.• No. of dental nurses hire/trained.• DMFT Index• No. of Dental Caries diagnosed

Dental diseases are largely preventable and increased emphasis on prevention

should be the goal of every dental practice.

““Knowing is not enough, we must apply. Knowing is not enough, we must apply. Willing is not enough, we must do.”Willing is not enough, we must do.”

- Johann Wolfgang von Goethe- Johann Wolfgang von Goethe