External Modifying Factors Involved in Dental Caries Introduction

External Modifying Factors Involved in Dental Caries
Awareness of the multifactorial nature of dental caries is of fundamental importance.
Figure 48 illustrates the interdependence of most of the determinate variables
associated with dental caries. Besides etiologic, preventive, and control factors, many
other factors may modify the prevalence, onset, and progression of dental caries. Such
factors may be divided into external (environmental) and internal (endogenous)
factors (to be discussed in chapter 3).
Factors that have proved, in cross-sectional studies, to be significantly associated with
increased prevalence of a specific disease are termed risk indicators (RIs). Factors
that have proved, in well-controlled prospective studies, to increase significantly the
risk for onset or progression of a specific disease are termed risk factors (RFs) and
prognostic risk factors (PRFs), respectively. The RF and PRF are often expressed as
the odds ratio for the onset or progression of a specific disease.
Among external modifying RIs, RFs, and PRFs for dental caries are fermentable
carbohydrates, poor socioeconomic status, systemic disease, medication that impairs
salivary function, and irregular dental care attendance habits.
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Articles for theme “caries”:
Prediction and prevention of cariesThe younger the population and the lower the caries prevalence in the population, thehigher the percentage of caries-free subjects. In these populations, it is necessary tofocus on “high-risk strategy” and primary prevention, rather than secondaryprevention.For practicing primary prevention according to the high-risk strategy, the etiologicfactors used for caries prediction must be as sensitive as possible, that is, optimizingthe percentage of true high-risk individuals for cost effectiveness.
Rationale for combining salivary MS tests and PFRI for prediction of caries risk Like the inflammation induced in gingival soft tissues adjacent to dental plaque, carious lesions that develop on the individual enamel surface beneath bacterial plaque should be regarded as the net result of an extraordinarily complex interplay between harmless and harmful bacteria, antagonistic and synergistic bacterial species, their metabolic products, and their interaction with the many other external (fermentable carbohydrates etc) and internal (saliva and other host factors) modifying factors,which are discussed in more detail in chapters 2 and 3.
Selection of caries-risk patientsInability of a sole salivary MS test to predict caries riskAs already mentioned in this chapter, numerous cross-sectional as well as longitudinalstudies have shown significant correlations between salivary MS levels and cariesprevalence and caries incidence (for review, see Bratthall, 1991; Bratthall andEricsson, 1994; Beighton et al, 1989). At the surface level, even more significantcorrelations between MS colonization and caries incidence have been found(Axelsson et al, 1987b; Kristoffersson et al, 1985).
Accuracy ofrisk assessments in practiceA perfectrisk marker would have a sensitivity of 100% and a specificity of 100%, implying noerrors in risk assessment. Consequently, the false-positive and falsenegative rates wouldbe 0%, and positive and negative predictive values would be 100%.Having perfect accuracy means that the predicted high-risk group would consist ofonly true high-risk individuals and that only true low-risk individuals would be includedin the predicted low-risk group.
Prediction of Caries RiskPrinciples of risk predictionSome basic principles have to be followed for successful and cost-effective cariesprediction, caries prevention, and caries control:1. The higher the risk of developing caries for most of the population, the moresignificant the effects of one single preventive measure and the stronger thecorrelations between one single etiologic or modifying risk factor and the risk forcaries development.2. In populations in which only a minority of the people will develop new cariouslesions, it is necessary to use accurate risk predictive measures to select at-riskindividuals and introduce needs-related combinations of caries-preventive measures,in other words, a “high-risk strategy.