 Hello everyone, welcome back to a new session on dentistry. Today we have epidemiology of dental caries. So this will be into three parts. The first part is basic epidemiology and other details. The second part is epidemiology and dental caries. That is the historical studies of the epidemiological studies which proved dental caries is caused by or it is connected to that. And the third part is sugar substitutes. So let's see what are the three factors of epidemiology. So epidemiology the definition we know we have learned that is distribution and determinants of health states or events in specified population and application to control this particular disease. And the dental caries definition is irreversible microbial disease of calcified tissues which is characterized by deminialization of inorganic and destruction of organic which leads to cavitation. So caries is derived from Latin word rot means decay it literally means death. So it is a multifactorial disease and this is known as disease of modern civilization because it was very rare in the previous era. After the civilization the dental caries is becoming a pandemic. So there is always a caries balance that is happening in our mouth. The protective factors are saliva, the antimicrobials, fluorides and effective diet. So it tries to protect our teeth but at the same time bacteria 0 stomia that is absence of saliva and other dietary habits that is excess consumption of vasogorhose will always try to produce caries. So this balance is very important. So more we concentrate on the protective factors caries will not happen and once the balance is lost caries will occur. So we have various theories of caries formation the most common one is Miller's chemical parasite theory. So there were many theories behind this behind before this Miller's theory. The most famous theory is Miller's chemical parasite that is bacteria sugar plus teeth becoming organic acid and dental caries. Then proteolytic theory by Gottlieb that is organic portion by destruction by proteolytic organisms. Proteolytic chelation theory by Schatz et al. There will be a chelation process happening. Sucrose chelation theory by Achilles-Laura 1967 and few other theories like autoimmune theory by Berger and Jackson. So this is a chronological trial by Achilles in 1960. So we have learned a chronological trial in our concept of causation. So there will be three factors that is host, agent and environment. So host is always the teeth. Agent is outside organism that is microorganism. Environment is a diet and many other factors. So in agent factors we have microorganisms dental, plaque, diet and nutrition. So here it is mentioned in environment. It comes under agent also. So in host factors race, age, sex, familial history, socioeconomic status, quality and quantity of tooth. Environment, fluoride, race element, social factors, geographic variations, urbanization. So there is a tritrade explanation of this epidemiology called triad by Neobron in 1982. So he added time factor to this triad and it became tritrade. So always epidemiological triad cannot fully explain the dental caries mechanism. So he added time factor because it always involves a time because the sucrose should be there at oral cavity for a particular period of time for this acid production. Otherwise the caries will not happen. So time is important factor. So Neobron added this time in 1982. So it became tetrad instead of triad. So host factors are race, ethnicity, age, sex, familial history, emotional disturbance, diet and socioeconomic status, tooth and saliva. So race and ethnicity that is global variation carries experience results from environmental factors rather than inherent racial attributes. So belong to one particular race will not give any immunity to dental caries. So it is based on the factors not due to the racial attributes. Because some racial groups once thought to resistance to caries but actually it was due to their dietary pattern. Age, there are three peaks of increase in age that is 4 to 80 years, 11 to 90 years and 50 to 60 years. So these years are involved with new eruption of many teeth. So that's why it's known as this age is for root caries becoming a disease of lifetime. So coronal caries, streptococcus mutants are mainly involved and root caries atomizes. Root caries is common in all to age. Success shown that females have more caries. Root caries is more common in males. Why females are in more caries because the early eruption of teeth morphological differences and their increased fullness of sweets and also due to hormonal changes. Familial history it is said that good or bad teeth run in family. So there is a familial or a genetic element which is involved in dental caries. Now because it has proven and studied that actually it is not the genetics but the same pattern of teeth that is morphology, occlusion, salivary flow and other factors which involving the caries pattern in family rather than the genetics by itself. So emotional disturbance stress is always associated with high caries incidence because they do not take sufficient self care if people who are under stress just like the schizophrenia patients. Because there will be reduced caries, sorry reduced caries and schizophrenia is opposite because there is a reduced caries which is due to the increased salivation and high pH of saliva. So I was talking about the stress factor when stress is there people tend not to take care of their teeth schizophrenia due to the excessive saliva production. So diet and nutrition, malnutrition is always associated with hypoplastic teeth. So in turn it leads to dental caries. So gross is known as arch-criminal. Vitamin D deficiency also a causative factor for hypoplacian which causes or which can attribute to development of caries. Social economic status is like low social economic status more decayed and more missing component. In high social economic status they can afford more treatment. So filling component is more. So around 1960 after the introduction of fluoride what happens is the higher socioeconomic groups they can afford toothpaste and other fluoride products. So caries were reported less in that group and nowadays caries is seen most commonly in poverty and it is becoming a social behavioral disease because lower socioeconomic groups are not able to do a proper oral hygienic issues. So that is becoming a part of a social and behavioral pattern and nowadays it is commonly seen among the lower strata of society. So time factors this was the most important thing we had seen the dental caries was most common among 4 to 8, 11 to 18 age groups because those period of time there were so many teeth newly ruptured into the oral cavity. So this newly ruptured teeth are not very much mineralized there is still mineralization left post eruptive mineralization will happen within 2 to 3 years. So this period is very critical and caries will be more common during this period of time. So tooth factor it has like we know this composition map enamel has 96 percentage in organic and dentine has 65 percentage, cementum has 45 percentage. So enamel, dentine, cementum, tooth position is important because if it is malaligned out of position rotated such cases there will be more caries because of the oral hygiene measures won't be accurate or proper in this scenario. Tental caries of primary teeth most commonly mandibular molars are affected than maxillary molars than maxillary anterior teeth least were seen around in lower incisors. Permanent teeth which is mandibular 1st and 2nd molars than maxillary 1st and 2nd molars mandibular primolars for maxillary primors likewise. The mandibular central lateral and condenser least caries reported teeth saliva which has directly connected to caries regarding the flow rate because if a good flow is there there will be less caries if flow is less because it is more there will be more caries but these are the saliva constants. So pH increases with flow rate so decrease pH more caries increase pH less caries. So quantity, thick immutinous saliva is always associated with high caries incidence and if there is lack of adequate saliva production there will be more caries because saliva flow will be reduced in zero storm or other conditions so there will be more caries. And antibacterial properties are there in saliva like lactoperosidase which limits early microbial colonization and lysozyme which degrades angrily charged peptidoglycan matrix. Lactoferin and IgA. Lactoferin is an ion binding basic protein which tends to bind and limit the amount of free iron. IgA is immunoglobulin present in saliva which prevents colonization bacteria. So agent factor we have microflora and diet so diet we have already seen in our host factor. So host factor already we have covered this diet. So the same diet can be put into host and agent factor because diet is like nutrition and diet we cannot keep in one category because it is interlinked to host and agent factors. So microflora we know what bacteria versus dental caries is streptococcus mutus mutants and saliva rays and other factors and what they do is they produce acids and versus the immunolization. So streptococcus mutants starts the caries. Lactobacillus associated with dental caries because it is both acido-genic and aciduric. It can produce acid it can withstand at an acidic environment but streptococcus mutants cannot withstand an aerobic condition. So that as caries causes deep into the cavity there will be less oxygen content. So the streptococcus mutants will be replaced by lactobacillus because it is acidic. Atomicosis are always seen in root caries. So that the content the carbohydrate and vitamin content is important because fermentation happens by the presence of bacteria on the black and produces demonalization and caries. Physical nature is more sticky content and less easy to be cleansed such materials will cause more caries. So because the diet of primitive man always associated with ruffage content which is very less in modern diet because modern diet is soft and refined food. So it will cling to the teeth and in all easy to get removed. So more caries seen in modern civilized people. So sucrose is known as ash criminal because the amount of acid produced from one unit of sucrose is very large compared to other forms of carbohydrate such as fructose, galactose. So vitamin A is important because it is involved with the development of teeth. If it is deficient there will be chances of caries. Similarly vitamin D is associated with the formation of enamel. So lack of these vitamins enhance the caries formation. Similarly vitamin K is an anti-caries agent. It has an enzymatic inhibiting activity. So vitamin B6 also anti-caries agent. Calcium and phosphorus. So this calcium and phosphorus metabolism is important because if it is not adequately obtained there will be hyperplacium. Similarly fluoride we have seen in our fluoride chapter our fluoride prevents dental caries. So good fluoride content means there will be low caries incidents which is commonly available in tea leaves fish. So this diet and dental caries epidemiological studies I will be covering in my next video. So let us move on to the environmental factors that is the last factors. We have covered agent and host factors. So environmental factors is a tricky part because it has no good scientific evidence to prove all these factors. It comes major, it comes under major geographic variations, urbanization, nutrition and social factors. So latitude, distance from sea coast, sunshine, temperature, humidity, rainfall, fluoride. Many things are coming here. Let us see the latitude. It is said that people living near equator are having less caries compared to average from equator. People who live near the sea coast are having more caries and if we go away from sea coast less caries, sunshine it is associated with vitamin D less sunshine, more caries or you get more sunshine, less caries. Like I said there is no direct link between these factors and dental caries. So temperature, people with cold temperatures tend to consume more baked goods so more caries. Humidity shows higher correlation with caries prevalence because humidity or the moisture, the atmosphere will block the UV rays and sunlight. So it is affecting our teeth formation and increased caries activity. So rainfall, it acts by leaching of minerals including fluoride from the soil and blocking the sunlight. So rainfall and humidity are linked to dental caries, prevalence or it causes increased fluoride. We know it prevents dental caries, water hardness, there is an inverse relationship. Selenium, trace element selenium increases caries whereas molybdenum decreases caries. So urbanization we know that air carries goes in urban areas due to the higher consumption of refined food stuffs. So nutrition we have already seen how nutrients are affecting. So the nutrients is coming everywhere as we see it is interlinked into the environmental post and Asian factors. So it is included under the environmental factors as geographical, cultural, educational factors might influence food availability and in turn might contribute to increasing or decreasing caries. In social factors the economic status is a determining thing because if economic status is well, the patient's affordability and his provision for good preventive measures are good. Definitely there will be less chances of caries compared to the other group of economic strata. The dental care is quite expensive so the affordability is a very determining factor in the prevalence of dental caries. So let's see how do we prevent dental caries at various levels. So we have seen this primary, secondary and tertiary levels. We have learned this levels of prevention and modes of intervention. So health promotion, specific protection, early diagnosis and from treatment, disability limitation and rehabilitation. So in primary prevention we can do health promotion and specific protection. So we can adopt an individual approach, a dental professional or a community approach. So by individual we can plan out that, we can do the periodic dental visit. So in specific protection what individual can do is we can use fluoridated prescriptions, denturises, proper use of other fluoride products. But a dental professional can educate the patient, he can counsel the patient and he can topical fluoride, he can do topical fluoride application under specific protection and he can apply pit and fissure sealants whereas a community can prevent the dental caries by conducting programs, promotional activities and legislation. Specific protection, we can do community water fluidization or school water or other sealant school sealant programs. So this comes under primary prevention. This is commonly asked question how to prevent dental caries at various levels. But secondary prevention as we discussed in our concept of prevention disease already occurred. So we have to detect the disease at very early stage like person can do self-examination and also can visit a dentist whereas dental professional can complete do a complete examination and treatment of the early lesions that is incipient lesions and can do PRR and very simple restorative procedures and even pulp capping. Community can do a periodic screening process but Toshri means the disease has already gone to a very severe stage so individual can seek for a dental service whereas a dental professional need to do complex restorative procedures like pulpitomy, RCT and extraction. Community can again send for the patients for treatment. Rehabilitation in dental professional need to rehabilitate using RPD or FPD or other things. So this is like levels of prevention of dental caries at various levels that is primary, secondary, Toshri this comes under all the main diseases like periodontal disease, oral cancer. So this is how prevent systematically and scientifically a disease. So that is all about prevention. So the video includes the epidemiology of dental caries, various factors, agent, host and environmental factors and the levels of prevention. So it's a simple chapter not much complicated. Riot comes in all the factors that is inter connected and epidemiological triad later advanced to a epidemiological triad. The fourth factor time has been introduced by Newborn because time is a big element in formation of dental caries. So that's all about epidemiology of dental caries. The second part of this video includes diet and dental caries that is the epidemiological studies which has proven how the diet is a causative factor or how diet is linked to dental caries and another part is sugar substitutes. So there are three parts for this epidemiology of dental caries. So thank you for watching. I'll come up with the epidemiology of dental caries, part two, the diet and epidemiological studies. Okay. Thank you.