Epidemiology of Dental Caries Introduction

Epidemiology of Dental Caries
An important function of the World Health Organization (WHO) Oral Health Unit is  the collection and analysis of global epidemiologic data on oral diseases, recorded in national, computer-aided studies. Goals for the level of oral health status are set and revised at certain intervals. Because epidemiologic studies measure dental caries in groups or populations, some care must be taken to ensure that the same diagnostic criteria are applied to each individual examined.
Dental caries presents interesting challenges for epidemiologists. For example, the signs of the disease (lesions) may be found on several sites and/or several teeth in the individual and frequently vary in severity. Carious lesions exhibit a broad spectrum of clinical features, depending on how far destruction has progressed on a particular surface. Early demineralization may be detected only with the aid of sophisticated techniques, such as radiography, or after careful cleaning and drying and meticulous examination of the surface. In the more advanced lesion, cavitation is readily
detected. At the intermediate stages, the broad range of clinical signs represent past or current carious attack.
For the results of a particular study to be meaningful, the researchers must establish certain criteria:
1. To fulfill the purpose of the investigation.
2. To allow consistency in application by the examiner over the period of the study (reproducibility).
3. To allow consistency between examiners (if more than one is involved).
4. To establish external validity (ie, measure what they are supposed to measure).
5. To provide a pathobiologic rationale (ie, actually reflect the disease).
There is no gold standard for caries in epidemiologic studies. The most important determinant should be the purpose of the study.
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Articles for theme “caries”:
ConclusionsDevelopmentA carious lesion should be regarded as damage resulting from the infectious disease dental caries. The coronal lesion starts as clinically undetectable demineralization of enamel, visible only at the microscopic level, and proceeds gradually to visible, noncavitated demineralization of first the enamel surface and then the dentin, and finally to cavitation of the dentin. Primary carious lesions are most frequently located supragingivally on the crowns and particularly on the occlusal surfaces of the molars and the approximal surfaces of the posterior teeth.
Diagnosis of secondary cariesDefinition and prevalenceSecondary caries has been reported to be eight times more common than primary lesions in adults, particularly in those older than 50 years (Goldberg et al, 1981). However, prevalence may vary markedly in different countries, depending on the total caries prevalence in the population and the level of development of the dental care system. In developing countries with low caries prevalence in the adult population and poor dental care resources, secondary caries may be almost negligible.
Diagnosis of root cariesDefinition and classificationRoot caries usually appears as a shallow area, less than 2 mm deep, a mostly noncavitated, ill-defined, softened, and often discolored lesion, characterized by destruction of cementum and penetration of dentin. Several definitions and classifications have been proposed; Hix and O’Leary (1976) defined root caries as “a cavitation or softened area in the root surface which might or might not involve adjacent enamel or existing restorations (primary and recurrent lesions).
Diagnosis of approximal cariesThe issues to be considered by the clinician with respect to caries of the approximal surfaces are similar to those considered at other sites: Is the surface sound, or is there a lesion? If so, how advanced is the lesion¾involvement of enamel only, enamel and dentinal involvement, or pulpal exposure? Finally, is there cavitation?  Diagnostic methodsMeticulous visual examinationIn the thin anterior teeth, both noncavitated and cavitated approximal lesions are readily detectable by meticulous clinical visual examination.
Diagnostic methodsIn typical fissures, and particularly in atypical sticky fissures (see Fig 203), most of the early stages of the lesion are hidden from the naked eye, although in a clean, dry fissure, it might be possible to observe active noncavitated white-spot lesions on the walls. Soon after eruption, most of these lesions are arrested (see Figs 174, 204a-c, 205c) and take up a brown stain from items in the diet. This diagnostic problem was recognized many years ago by GV Black (1908) who wrote: Very many pits and fissures show evidence of some slight softening in early youth, which is stopped by the coming of immunity or some change of local conditions.