Prevention in Clinical Oral Health Care

David P. Cappelli, Connie Chenevert Mobley

• Publisher: Mosby
• Year: 2007
• eBook ISBN: 9780323058360
• Topic: Medicine
• Subtopic: Dentistry

This book focuses on oral health promotion and the impact of systemic disease in the development of oral disease, as well as how to introduce, apply, and communicate prevention to a patient with a defined risk profile. Prevention in Clinical Oral Health Care integrates preventive approaches into clinical practice, and is a valuable tool for all health care professionals to integrate oral health prevention as a component of their overall preventive message to the patient.- Discusses risk-based approaches to prevent problems such as caries, periodontal disease, and oral cancer.- Topics are written at a level that can be understood by both practicing dental health team members and by dental hygiene and dental students so strategies can be applied to better understand the patient's risk for oral disease and how to prevent future disease.- Identifies the barriers, oral health care needs, and preventive strategies for special populations such as children, the elderly, and the physically or mentally disabled.- Explores the development of a culturally sensitive dental practice and strategies to make the dental environment more welcoming to individuals with different cultural backgrounds.- Discusses how to gather patient information, the synthesis of the patient's data, and the application of the information collected in order to evaluate the patient's risk for disease.

Part I

EPIDEMIOLOGY AND PREVENTION THEORY

Chapter 1 Epidemiology of Dental Caries

JAY D. SHULMAN, DAVID P. CAPPELLI

CARIES EPIDEMIOLOGY

THE SCIENCE OF CARIES

TYPES OF CARIES

POPULATION-BASED MEASURES OF CARIES

Coronal Caries

Early Childhood Caries

Root Caries

Definitions of Risk

Geographic Variation

Secular Trends

Sociodemographic Factors

Age

Gender

Race and Ethnicity

Income

Concentration of Caries

Life Course

Healthy People 2010

SUMMARY

LEARNING OBJECTIVES

Upon completion of this chapter, the learner will be able to:

• Explain the biological process of caries development

• Describe etiological factors associated with caries

• Examine population-based measures of dental caries

• Discuss trends in caries prevalence

• Outline the Healthy People 2010 caries objectives

KEY TERMS

Caries balance

Confidence limits

Decayed, missing, Filled (DMF)

Demineralization

Dental caries

Enamel caries

Early childhood caries

National Health and Nutrition Examination Survey (NHANES)

Remineralization

Dental caries remains the most prevalent chronic childhood disease and is five times more prevalent than asthma.¹ This chapter provides foundational knowledge about the prevalence and trends of dental caries in the population, and explores population-based measurement systems. Dental caries is described as a disease process and the causal profile of the disease is outlined. Surveillance methods and disease trends in the U.S. population for both children and adults are described by using data from several national surveys. The National Health and Nutrition Examination Survey (NHANES) series comprises NHANES I (1971 to 1974),² NHANES III (1988 to 1994),³ and NHANES (1999 to present)⁴

CARIES EPIDEMIOLOGY

Dental caries is a diet-dependent, transmissible, microbiologically mediated disease.⁶ Similar to periodontal disease, it follows both an infectious and chronic disease model. The microorganisms that cause dental caries are transmitted vertically from mother to child soon after tooth eruption.⁷ Studies indicate that the greater the delay in transmission, the lesser the caries burden through life.⁷ Once caries is established, prevention focuses on the mitigation of risk factors that contribute to disease. Dental caries is caused by the interrelationship of multiple factors over time (Figure 1-1). These factors were described by Keyes in the 1960s using a Venn diagram (see Figure 4-1) of intersecting causal circles.⁸ Modifications of this model appear in the literature, but all have their basis in the original Venn diagram. The cause of dental caries is related to a number of factors that are categorized into host susceptibility, microorganism, and substrate. All of these factors must intersect during a defined period of time, along a continuum, for caries to occur.

Figure 1-1 Diagrammatic presentation of factors involved in caries development, including substrate, host, and organism over time.

Dental caries is a dynamic process of demineralization and remineralization of tooth structure⁹ in which oral biofilms mature and remain on the tooth for a prolonged period of time.¹⁰ Early detection methods (described in Chapter 4) allow incipient lesions to be identified before the caries spreads into the dentin. Evidence-based prevention strategies allow intervention at this early stage to reduce tooth morbidity or mortality. These strategies, described in Chapter 15, include the use of fluoride and dental sealants to inhibit the progress of caries. This phenomenon has been described in the literature as caries balance.¹¹

Caries balance (Figure 1-2) suggests that the process of demineralization and remineralization occurs as a dynamic between pathological and protective factors.¹² In a state of equilibrium, these factors are in balance. The demineralization process predominates when the pathological factors outweigh the preventive factors. If this process continues unchecked, a carious lesion can form. The key is to intervene and reduce the effect of these factors through a process of risk assessment and prevention planning. Similarly, the remineralization factors predominate when the preventive factors supersede the pathological factors. The list of pathological factors is adapted from the original Keyes concept and includes exposure to fermentable carbohydrates, decrease in salivary flow, and an increase in oral pathogens. Caries induction and progression are related to exposure to sugars and other fermentable carbohydrates. The role of diet in caries formation is presented in Chapter 8. Sufficient salivary flow is important to maintain mechanical cleansing of the oral cavity, to buffer against the acids produced by the organisms in the plaque, and to facilitate the host response to the pathogenic microorganisms in the plaque. Acidogenic bacteria have been implicated as an indicator in the formation of dental caries. Therefore, the proliferation of these organisms can be linked to the formation of a carious lesion.¹²

Figure 1-2 The caries balance concept. Relationship between pathological and protective factors in caries development.

(Adapted from Featherstone JDB: Caries prevention and reversal based on the caries balance, Pediatr Dent 28:128-132, 2006.)

This balance between pathological and preventive factors is an ongoing process of demineralization and remineralization. Dental caries is a process or continuum of events over time (Figure 1-3). This cycle of demineralization and remineralization is affected by the presence of inciting factors, cariogenic bacteria and fermentable carbohydrates, and the balance with protective factors, including saliva, fluoride exposure, plaque control, and healthy diet. Over time, this demineralization-remineralization phenomenon can lead to cavitation, reversal of the lesion, or a static state with neither mineral loss nor gain.¹⁰

Figure 1-3 Diagram of the continuum of demineralization and remineralization in caries.

(Adapted from Kidd EAM, Joyston Bechal S: Essentials of dental caries, the disease and its management, ed 2, New York, 1997, Oxford University Press.)

The current trend in caries reduction is away from the surgical model ...

Table of contents

• Cover
• Title Page
• Copyright
• Contributors
• Foreword
• Preface
• Table of Contents
• Introduction: Integrating Preventive Strategies into Clinical Practice
• Part I: EPIDEMIOLOGY AND PREVENTION THEORY
• Part II: RISK-BASED PREVENTION
• Part III: ASSESSMENT STRATEGIES TO TAILOR YOUR PATIENT CARE PLAN
• Part IV: PREVENTION AND PRACTICE
• Glossary
• Index