A Textbook of Public Health Dentistry is designed for undergraduate and postgraduate students in dentistry as well as health professionals with an interest in understanding and promoting oral health within communities.
Although Public Health Dentistry is concerned with oral health of the population rather than dental needs of an individual patient, the ultimate beneficiary of public health programs is an individual. As expected in a book of Public Health Dentistry, epidemiology, etiology, and preventive measures in context of dental caries, periodontal diseases and oral cancer have been discussed in detail.
Extensive coverage has been given to the role of fluoride in the prevention of dental caries. Knight and Hester J. Ward 9. Kamb and John M. Douglas, Jr. Morrow and William J. Moss 9. Heymann Section 10 Prevention and control of public health hazards Bettcher,1 Jonathan Samet, Krishna M. Des Jarlais and Robert L. Hubbard Hyder Sidel and Barry S. Levy Montgomery Leave a Reply Cancel reply Comment.
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The carious lesion forms a triangular or coneshaped lesion with its apex at the outer surface and base towards the dentinoenamel junction DEJ. It is almost invariably present, being broader beneath the lesion than at the sides and is regarded as a vital reaction of odontoblasts to irritation.
Sclerosed dentine has a higher mineral content. Dead tracts may be seen running through the zone of sclerosis. They are the result of death of odontoblasts at an earlier stage in carious process. The early dentinal tubules contain air and the remains of dead odontoblastic process and such tubules cannot undergo sclerosis.
However, they provide ready access of bacteria and their products to the pulp. The caries process in dentine is approximately twice as rapid as in enamel.
Spread of caries is more in dentine compared to enamel because of: 1. Decreased calcification mineralization. Existence of pathways dentinal tubules. Advanced carious lesions in dentine consist of two distinct layers having different microscopic and chemical structures.
The outer layer is heavily infected by bacteria which are mainly located in the tubule spaces. The collagen fibers are denatured and the organic matrix is not being remineralized. The inner layer is scarcely infected, but affected by plaque acid Fig.
It still contains high concentrations of mineral salts and can be remineralized. The initial dentinal changes are known as dentinal sclerosis or transparent dentine.
The dentinal sclerosis is due to calcification of dentinal tubules. The change is minimal in progressing caries and more in slow caries. In transmitted light the dentine appear transparent. In reflected light sclerotic dentine appear dark. In advanced lesions tiny liquefaction foci are formed. In secondary dentine the dentinal tubules are fewer and irregular. Caries spread laterally at the junction of primary and secondary dentine separating both. Various zones are distinguished assuming the shape of triangle with the apex toward the pulp and the base toward the enamel.
Firstly the fatty degeneration of the tomes dentinal fibres resulting in deposition of fat globules in the further end of dentinal tubules. Impermeability of the dentinal tubule. Also sclerosis of dentinal tubule. Zone of Demineralization In the demineralized zone the intertubular matrix is mainly affected by a wave of acid produced by bacteria in the zone of bacterial invasion, which diffuses ahead of the bacterial front.
The softened dentine in the base of a cavity is therefore sterile affected dentine but it cannot be distinguished from softened infected dentine. It may be stained yellowish-brown as a result of the diffusion of other bacterial products interacting with proteins in dentine. Zone of Bacterial Invasion In this zone the bacteria extend down and multiply within the dentinal tubules, some of which may become occluded by bacteria.
There are always, however, many empty tubules lying among those tubules containing bacteria. The bacterial invasion probably occurs in two waves: the first wave consisting of acidogenic organisms, mainly, lactobacilli produce acid which diffuses ahead into the demineralized zone. A second wave of mixed acidogenic and proteolytic organisms then attack the demineralized matrix. The walls of the tubules are softened by the proteolytic activity and some may then be distended by the increasing mass of multiplying bacteria.
Liquefaction foci run parallel to the direction of the tubules and may be multiple, giving the tubule a beaded appearance. Zone of Decomposed Dentine In this zone the liquefaction foci enlarge and increase in number. Bacteria are no longer confined to the tubules and invade both the peritubular and intertubular dentine. In acute, rapidly progressing caries the necrotic dentine is very soft and yellowish-white; in chronic caries it has a brownishblack color and is of leathery consistency.
This occurs before sclerotic dentine is formed and makes the tubules impermeable. Zone 2: Zone of dentinal sclerosis characterized by deposition of calcium salts in the tubule.
Zone 3: Zone of decalcification of dentine, a narrow zone preceding bacterial invasion. Zone 4: Zone of bacterial invasion of decalcified zone but intact dentine. Zone 5: Zone of decomposed dentine due to acids and enzymes. Three indispensable factors for development of caries were: 1 carbohydrate diet , 2 bacteria dental plaque , and 3 susceptible teeth the host Keyes and Jordan, Since then, many modifying factors have been recognized, resulting in a more complex model that includes saliva, the immune system, time, socioeconomic status, level of education, lifestyle behaviors, and the use of fluorides.
An important breakthrough in the understanding of dental caries was the recognition of the remineralization process as a result of plaque fluid and saliva at pH levels above a critical value being highly saturated with calcium and phosphates.
The caries process can be described as loss of mineral demineralization when the pH of plaque drops below the critical pH value of 5. Redeposition of mineral remineralization occurs when the pH of plaque rises. The presence of fluoride reduces the critical pH by 0. It is now established that dental caries is a multifactorial disease and results from a combination of four principal factors Fig.
Host and teeth factors: 2. Microorganism in dental plaque 3. Substrate [diet] 4. Mandibular 1st and 2nd molars. Maxillary 1st and 2nd molars. Mandibular 2nd bicuspids, maxillary 1st and 2nd bicuspids, maxillary central and lateral incisors.
Maxillary canines and mandibular 1st bicuspids. Mandibular central and lateral incisors, mandibular canines. Third molar had not erupted in the children studied. Sex D. Age E. Race and ethnicity F. Socioeconomic status G. Heredity H. Emotional disturbances B. Tooth Agent Factors A. Microorganism B. Plaque Environmental Factors A. Composition: Number of studies on the relation of caries to the chemical composition have shown that there was no difference found in the calcium, phosphorus, magnesium and carbonate content of enamel from sound and carious teeth.
But there was a significant difference in fluoride content of teeth, i. It was also noted that surface enamel is more resistant to caries than subsurface enamel.
Surface enamel is more highly mineralized and tends to accumulate greater quantities of fluoride, zinc, lead and iron than the underlying enamel.
The surface is lower in carbon dioxide, dissolves at a slower rate in acids and has more organic material than subsurface enamel. These factors contribute to caries resistance. Morphology: Morphologic features which may pre dispose to the development of caries are the presence of deep, narrow occlusal fissure or buccal or lingual pits.
These fissure trap food, bacteria and debris leading to development of caries. Position: Malaligned, out of position, rotated teeth are difficult to clean, favoring the accumulation of food and debris. This may predispose to the development of caries.
Saliva It can be considered as an environmental factor also as teeth are constantly bathed by it. This influences the process of dental caries. Saliva has a flushing action on teeth. Composition: varies from person to person. Saliva is dilute fluid; over 99 percent being made up of water. Proteins: They include enzymes, immunoglobins and other antibacterial factors, mucous glycoproteins and certain polypeptides.
Immunoglobulins — secretary IgA 4. Antibacterial proteins —Lysozyme, Lactoferrin, Sialoperoxidase. Polypeptides — Statherin, Sialin helps to regulate pH of plaque. Saliva: It has a critical role to play in the development of caries or its prevention. Saliva provides calcium, phosphate, proteins, lipids and antibacterial substances and buffers. Saliva buffering can reverse the low pH in plaque. Buffering and neutralization: pH of saliva depends on the bicarbonate concentration.
Saliva is alkaline and is an effective buffer system. These properties protect the oral tissues against acids and plaque. After eating a sugary food if saliva is stimulated by chewing substances such as wax or sugar free chewing gum, the drop in pH in plaque which would have occurred is reduced or even eliminated. This salivary neutralization and buffering effect markedly reduces the cariogenic potential of foods.
Quantity: Rate of flow of saliva may be an additional factor which helps contribute to caries susceptibility or caries resistance. Mild increase or decrease in flow may be of little significance, near total reduction in salivary flow adversely affects dental caries. There is an inverse relation between salivary flow and dental caries. Sex In young people caries has been seen to higher in the females but some studies show no significant difference between the sexes.
Root caries is seen more in males. Girls may be more prone to caries due to early eruption of teeth and hormonal changes puberty and pregnancy.
Age Although present in all ages, it was believed that dental caries was disease of childhood. Some studies indicate greatest intensity of dental caries occurs in 15 to 25 years of age.
Root caries is seen in over 60 years age group people, mainly due to denuded root surface because of gingival recession. Race and Ethinicity A number of studies indicate that blacks [Negroes] of comparable age and sex have a lower caries scores than Caucasians.
Chinese population has shown to have a lower caries rate than corresponding white population. These differences are probably more due to environmental factors. Socioeconomic Status There is an inverse relationship between socioeconomic status and dental caries experience in primary dentition. The relation has not been established in adults, though some studies suggest so. Heredity Environmental factors have a greater influence than genetic factors but latter also contributes to the causation of caries.
Emotional Disturbances Emotional disturbances, particularly transitory anxiety states tend to increase the incidence of dental caries. Microorganisms The mouth has a diverse resident microbial flora. The normal inhabitants become established early in life. There have been a few epidemiological studies to investigate the link between oral flora and dental caries.
Streptococcus mutans was first identified in by Clarke and subsequently Lactobacillus acidophilus by Bunting These acid producing bacteria were found to be associated with the formation of dental caries.
Streptococcus mutans is of interest because it has the ability to Chapter 10 N Epidemiology of Dental Caries form an extracellular polymer of glucose, mutans from sucrose, which aids the microorganism in adhering to the enamel surface and in establishing a stable relationship there.
The absolute demonstration of a specific microorganism as the causative agent of dental caries in man may be impossible because of diverse organisms being always present in the oral cavity and on the teeth. Actinomyces are Gram-positive pleomorphic rods GPPR which form a large proportion of the oral microflora of all mammals. They have been implicated in root caries, although their role in dental caries initiation and progression is not wellunderstood. Dental Plaque Bacterial plaque is a dense non-mineralized, highly organized mass of bacterial colonies in a gel-like intermicrobial, enclosed matrix or slime layer.
It is a transparent film that can be supragingival, coronal to the gingival margin on the clinical crown of the tooth and subsgingival, apical to the margin of the gingiva. Diet According to acidogenic or chemoparasitic theory, dental caries occurs when acid is produced by bacteria in dental plaque when refined carbohydrates are eaten. The presence of refined carbohydrate as sugar is essential for the majority of caries development and sucrose is the most cariogenic of all sugars.
In human consumption, sucrose accounts for 60 percent of all sugars eaten. Geographic Variation It is well documented that dental caries experience has been decreasing in children in developed western [—] countries. But this decrease is beginning to level out. Gradual increase in caries in 5 years old have been found in some areas. Climate Sunshine and high temperature areas seems to have lower dental caries [inverse relationship].
Whereas areas with more relative humidity and rainfall have shown increase dental caries. Oral Hygiene Inverse relationship has been seen between oral hygiene and dental caries. Poor oral hygiene increases the rate of dental caries.
Soil Trace elements in soil have shown a relation with caries. An increase in dental caries is seen in areas where selenium is present in soil, whereas molybdenum and vanadium are said to decrease dental caries. Fluoride Fluoride in water and soil decreases incidence of dental caries.
Early childhood dental caries occurs in all racial and socioeconomic groups; however, it tends to be more prevalent in low-income children, in whom it occurs in epidemic proportions. Human dental flora is site specific, and an infant is not colonized until the eruption of the primary dentition at approximately 6 to 30 months of age.
To prevent caries in children, high-risk individuals must be identified at an early age preferably high-risk mothers during prenatal care , and aggressive strategies should be adopted, including anticipatory guidance, behavior modifications oral hygiene and feeding practices , and establishment of a dental home by 1 year of age for children deemed at risk.
Secondary recurrent root caries refers to caries occurring adjacent to an existing restoration. There is general agreement on this terminology. Root caries most often occurs supragingivally, at or close to within 2 mm the cemento-enamel junction. This phenomenon has been attributed to the location of the gingival margin at the time conditions were favorable for caries to occur. The location of root caries has been positively associated with age and gingival recession. This is consistent with the concept that root caries occurs in a location adjacent to the crest of the gingiva where dental plaque accumulates.
Root caries occurs predominantly on the proximal mesial and distal surfaces, followed by the facial surface. Early root caries tends to be diffused spread out and track along the cementoenamel junction or the root surface. More advanced root lesions enlarge toward the pulp. Interpretation of data from prevalence and incidence studies is complicated due to differences in diagnostic criteria, treatment decisions, and lack of homogeneity of the observed population. Nevertheless, it has been definitely established that the prevalence of root caries increases with age and is greater in the elderly population than in younger adults.
Although root caries affects younger age groups as well, the disease has become more prevalent in the geriatric population due to the increased retention of natural teeth. Root caries research studies have found that about onethird of the population up to sixty years of age experiences root caries. The prevalence of root caries in patients over sixty years of age ranges from 30 to 63 percent, depending upon the type of individuals studied and where the study took place.
There are certain teeth and surfaces that are more susceptible to the development of root caries. Molars are the most susceptible, followed in decreasing order by the premolars, canines, and incisor. It has also been found that the mandibular molars have the most root surface caries and the mandibular incisors the least. Root caries is generally more prevalent and severe among males than female.
Root caries also seems to be a problem among older people of lower socioeconomic status, those who have lost some teeth, do not maintain good oral hygiene, and do not visit the dentist on a regular basis.
Risk Factors Clinical studies suggest that only those root surfaces where the crest of the gingival margin is apical to the cernentoenamel junction are considered to be at risk for root decay. In another study, older adults developing root caries had a higher intake of sugary liquids and solid fermentable carbohydrates and starches than did subjects without root caries. Recent studies show that microflora differ on healthy and diseased root surfaces.
A higher number of Actinomyces species was found on healthy root surfaces than on diseased root surfaces. Also, high numbers of mutans streptococci were found in initial and advanced root lesions.
Root surface caries seems to be more prevalent on teeth already afflicted with coronal caries. Another risk factor for root surface caries in the elderly is xerostomia. File size: Privacy: public file.Share Textook Donate. No part of this publication should be reproduced, stored in a retrieval system, or transmitted a textbook of public health dentistry free download any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editor and the publisher. This book has been published in good faith that the material provided by the contributors is original. Every effort is a textbook of public health dentistry free download to ensure accuracy of material, but puublic publisher, printer and editor will not be held responsible for any inadvertent error s. In case of any dispute, all legal matters to be settled under Adobe reader for android 2.3 free download apk jurisdiction only. My wife Vandana for her constant encouragement and support. My children for making life worthwhile. Although Public Health Dentistry is concerned with oral health of the population rather than dental needs of an individual patient, the ultimate beneficiary of public health programs a textbook of public health dentistry free download an individual. As expected in a book of Public Health Dentistry, epidemiology, etiology, and preventive measures in context of dental caries, periodontal diseases and oral cancer have been discussed in detail. Extensive coverage has been given to the role of fluoride in the prevention of dental caries. The principal diseases of the mouth such as caries, periodontal disease and oral cancer are lifestyle dependent. A sound public health program can provide effective measures. Some of the topics have been contributed by highly downloda colleagues from other dental colleges, bringing greater depth to the subject. The contribution of some chapters such as epidemiology, statistics, and nutrition, by senior teachers in Faculties of Medicine, Malaysia is gratefully acknowledged. Forensic dentistry, Occupational a textbook of public health dentistry free download, Ergonomics in dentistry and Financial aspects of dental health practice are attracting greater attention these days. These topics have been included in this book. The book incorporates the latest syllabus. The study of Public Health Dentistry also involves an appreciation of aspects of several disciplines a textbook of public health dentistry free download sociology, psychology and health-related behavior, health economics, health promotion and health service organizational methods in preventive dentistry. Mar 27, - Download the Medical Book: A Textbook of Public Health Dentistry PDF For Free. This Website we Provide Free Medical Books for all Students. 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