Dental Caries as the Most Common Dental Disease in the Australian Population - Literature review Example

Dental Caries Introduction Dental caries is an existing tooth condition where the hard surface of the tooth decays gradually over a period of time. The decay process is mainly caused by acid produced by living bacteria in the mouth (Gericke, 2009). Dental caries is a very popular disease as most individuals worldwide suffer from it. The problem has been noted to be very common in Australia leading to a number of measures being set to reduce the problem. Considering that Australia is a densely populated country, the numbers of individuals suffering from the condition are very many. This has been a global issue for quite a while and it has led to the enhancement of the methodology applied in carrying out measurements of dental caries. Therefore, this paper is going to focus on the epidemiology of dental caries in Australia and methodological issues related to caries measurement. According to Thompson (2010), the disease is considered to be very infectious and the diet that an individual is accustomed to is considered the main contributor. The acid that corrodes the surface is produced by bacteria that are found in the mouth, which are; streptococcus and lactobacilli. The food that an individual consumes may contain sugar or glucose, this is food for the bacteria and the acid is produced as waste product (Riordan, 2010). This may be a continuous process that eventually causes the decay of the hard enamel of the tooth. Therefore, the main risk factors that contribute to the decay of the tooth are; the carcinogenic bacteria, the carbohydrates that ferment at a high rate, availability of the tooth and the mouth which acts as a host and time. Carcinogenic bacteria Presence of the bacteria streptococcus and lactobacilli contribute to the decay of the tooth. These bacteria produce acid that have a corrosive effect on the surface of the tooth leading to demineralization of the enamel (Rigmont & Wilkins, 2002). The main way of controlling the effect of the bacteria on the teeth is by maintaining Sugar and related carbohydrates The ingestion of sugar and carbohydrates with a high rate of glucose in them is a major contributing factor in dental caries. Unless an individual is a diabetic and cannot be able to consume sugars, then they are likely to suffer from dental caries at some point in their lives. In Australia, sugar consumption is regular habit as it is part of their diet and this places their teeth at risk of decay. The bacteria feed on the sugar ingested by an individual and helps produce the acid as waste (Ismail, 2002). One should be able to monitor the food they are consuming and make sure the diet contains less sugar. Regular brushing and flossing can also be very helpful in preventing tooth decay. Presence of tooth and mouth Since the tooth is the main area being affected, then its presence is a contributing factor as well. The bacteria acts on the tooth surface and since one cannot resolute to being toothless then it is better to maintain its hygiene (Kahan & Smith, 2004). The mouth provides a good breeding center for the bacteria as it is moist. The same solution applies here, where oral hygiene should be highly observed at all times. Time Time is a determining factor as well since the longer the tooth is exposed to the acidic environment the worse the effect will be. An individual should resort to regular check ups to ensure that the teeth are not infected with dental caries. The frequency by which the acid is exposed matters since the teeth are most affected during this period. Types of caries According to Ekstrand (2004), dental caries does not follow the same pattern in every individual; this is mostly seen to vary according to age. The disease does not attack all the teeth at the same time or level. It starts with the molars and then it progresses to the other teeth slowly. The next teeth to be attacked by the disease are the pre molars then the rest of the teeth may follow progressively. Since the tooth is not attacked as a whole, the dental caries is categorized according to the manner by which it attacks the tooth. Pit and fissures caries This mainly affects the enamel as the enamel assumes an inwardly shape since it folds to that direction. The enamel does not get the opportunity to fully fuse and this automatically leads to the formation of a depression in the area. This is a good surface for the dental caries to form and accumulate. These are known as fissures and are normally found on the molars and pre molars. On the other hand the pits are not deep depressions but are small ones form on the surface of the enamel. They are easy to locate and one does not realise they are present until later. It is possible for the dental caries to breed here as cleaning the teeth is rather difficult. Smooth surface caries Just like the name suggests, the caries occurs on the surface of the teeth but on the smooth regions. It is categorized into three types which are; proximal caries, which forms on the smooth surface between two neighbouring teeth. They cannot be detected easily as they re not visible to the eye or accessible with a dental explorer. Hence, the dentists tend to use the help of x- rays, which are very beneficial. Root caries Root caries is the other types of dental caries; it mainly affects the molars and the pre molars (Ekstrand, 2004). Unlike the coronal caries, this type of dental caries affects mainly the adults. This creates a distinction between the two caries as here the root is the main target. The main way to avoid this disease is to maintain a healthy diet and at the same time consult regularly with a dentist. This is bound to save many individuals the trouble of having to lose teeth at an early stage in their lives. With age, there may be easy loss of teeth but one can take measures to ensure that their teeth are intact even at old age. Dental caries in young children in Australia Through a survey conducted by the National Survey of Adult Oral Health (NSAOH), it has been concluded that most children in Australia are suffering from dental caries. This is a serious issue as it may affect the life of the child negatively in form of appearance and even some pain during the decay process (Horowitz, 2004). The main of this survey is to discover how many individuals are suffering from dental caries and methods that can be applied to improve the condition. Rampant caries is the main caries said to be affecting children in Australia. This type of decay affects mostly all the teeth in the mouth and can be quite disastrous. It might be quite difficult to protect the teeth of the children from this type of caries as it occurs immediately the teeth are formed (Thompson, 2010). Its process takes place very fast and if the condition is not dealt with immediately it may lead to the decaying of the incisor teeth as well. This takes place in a continuous pattern and is known as baby bottle caries as mentioned earlier. Hence, oral hygiene in children should start at an early age. Why dental caries is very common in young children has been a controversial issue. The problem has not only been in the industrialized countries but in the third world countries as well (Ernest, 2006). The answer lies in the intake of sugar levels as this is a common factor in all countries and sugar is a causative agent of dental caries. The problem can also be approached by the use of fluoride to help in the mineralisation process. The rate at which children are suffering from dental caries in Australia has been quite alarming at a global level. This is not a good thing for the children as the effect of the condition may affect the child later on. The survey conducted was able to create awareness for the parents as some of them were blinded by ignorance (Ismail, 2004). The fact that the child will lose their set of milk teeth does not mean they should not be taken care of. Therefore, with this discovery, parents are rather keen on watching the diet of the children. Children are quite fond of snacking on sweet foods and drinks but changing this with fruits and other healthy drinks is bound to improve the situation. Looking at the current records the rate of dental caries in children has greatly decreased. Dental caries in adults Adults are also big victims of dental caries in Australia and this is concluded from the survey conducted by the National Survey of Adult Oral Health (NSAOH). Coronal caries is the main type of dental caries that the adults are said to be suffering from. This type of caries is progressive and may take quite a long time before the victim feels the symptoms. Ekstrand (2004), further reports that Coronal caries is well known for its attack of the crown and it is very common in children. This may seem to be progressive in the life of the individual but when the child reaches a certain age of about 15 years the disease becomes dormant. It may appear quite easy for the caries to attack the teeth since the fissures are not fully developed. Hence, the coronal caries will easily attack the enamel of the tooth since it will not be as strong as predicted to be. The situation may remain quite the same for a while before the symptoms resurface. Looking at the gender factor, the disease seems to be more persistent on the girls rather than the boys. This factor may be attributed to the fact that girls seem to produce teeth at a slightly earlier age than the boys. Hence, coronal caries mainly focuses on the crown. Due to the time taken by the coronal caries to finally start affecting the life of the individual, the data collected showed that the number of adults suffering from caries is very many. The survey carried out between the years 1987- 88, showed that the population of Australia was greatly affected by dental caries. When compared against other countries it was rated among the top countries suffering from dental caries. This raised an alarm among the residents leading to measures being taken that would reduce the rate of dental caries in the country. This made a great difference because looking at the results of the survey of the years 2004- 06, there was a great improvement among the people according to various age groups. The study is conducted according to specific age groups because dental caries affects different individuals from different age groups at different levels. Diagnosis Thompson et al, (2002), reports that the diagnosis process is simple as well as it involves the dentist carrying out a thorough inspection of the teeth by use of the mirror or dental explorer. This is the primary diagnosis since the caries is visible to the naked eye and is easily detectable. In other cases, the diagnosis process is as simple as blowing air on the surface that is suspected to be infected by caries. In other cases where the decay may be internal, the use of x-ray is applied (Thompson et al, 2002). This is important as the caries may be internal and the enamel of the tooth may have re-mineralized and created a new cavity for the tooth. Dentists are advised to approach with caution areas where the cavity may be in the process of rebuilding itself since the dental explorer may cause damage. Treatment According to Gericke et al, (2010), Decayed teeth can be treated and the tooth saved but if the tooth had decayed severely, then the only option is to remove it before it causes further damage on the gum and other teeth. Although, the enamel may seem to rematerialize itself, the process is not complete as there are some areas that are still left uncovered by the enamel. In most cases the priority of the dentist is to save the tooth structure by giving it artificial enamel that provides the same functions as the original one. This prevents further damage in form of decay to the tooth and is also not painful as compared to when the tooth is very decayed. Filling of the tooth is required to stabilize its functionality since it is a restorative process and it will help stop further decaying of the tooth. This has been quite effective as the results achieved are impressive. The new crown may be made to look like the rest of the teeth by coloring it in a manner that resembles the rest. Gericke et al, (2010) further observes that, in areas where there the pulp of the tooth has been greatly affected by the decay, root canal is usually conducted on the patients. This is a process where the nerves and other rotten areas are removed. All living tissue is removed for the area since it had been decayed and now can no longer be sensitive to pain. Dental caries measurement The measuring of dental caries has currently improved and the International Caries Detection and Assessment System (ICDAS) are currently being used. Some of the traditional methods that were deployed were discovered to be missing out some important information and the development process begun (Ismail et al. , 2007). The change process was engineered by professionals which included; caries researchers, restorative dentists and epidemiologists. The conclusion was that the dental caries will be measured depending on the tooth surface since dental caries is an\ progressive disease. This new method was discovered during one of the caries clinical trials (CCT) held in Scotland in 2002. The main aim for the formation of the ICDAS is to provide a wide field that the clinicians can be able to expand their research process by selecting the caries process that beast suits their level of research. This helps the clinicians in the decision making process as it provides more choices and the measurements can be carried out accordingly. ICDAS employs two main processes when detecting dental caries on a coronal tooth surface. Understanding the tooth surface so that it can be classified into various groups according to whether it is; missing, sealed, crowned or restored is the first stage observed (Ismail et al, 2007). This is done is done using specific codes since the tooth is divided into specific surfaces such as; mesial, distal among others. These are then divided into further sections that are important as well. some of the codes used to make the measurement process much easier are; Caries Detection and Assessment System (ICDAS) Code Description 0 Un-restored or unsealed 1 Sealant, partial A sealant that does not cover all pits and fissures on a tooth surface 2 Sealant, full A sealant that covers all pits and fissure on a tooth surface 3 Tooth colored restoration In the opinion of the dentist, the tooth has a tooth colored (resin or glass–ionomer cement) restoration 4 Amalgam restoration 5 Stainless steel crown 6 Porcelain or gold or PFM crown or veneer 7 Lost or broken restoration 8 Temporary restoration 9 Tooth does not exist or other special cases. Used in as the following: 9–6 ¼ Tooth surface cannot be examined because of access problem to visualize the tooth surface 9–7 ¼ Tooth missing because of caries (all tooth surfaces are coded 97) 9–8 ¼ Tooth missing for reasons other than caries (all tooth surfaces are coded 98) 9–9 ¼ Un-erupted (all tooth surfaces care The wardrobe concept is usually applied during the measurement process, which involves the coding process. Other surveys that might have been conducted earlier on the tooth surface can be used as a comparison base for the current survey (Ismail et al, 2007). This may turn out to be very helpful but there are some conditions that must be observed. The tooth surfaces that the surveys were conducted on may be made to resemble each other slightly so that the data may not appear so different. This where the coding comes into play as it helps one differentiate between surfaces that are sealed and those that are not fully sealed. Noting the colour of the texture is also an important point and the coding system helps create that contrast. The second stage usually applied is referred to as ‘distinct visual change.’ The lesion at this point is quite visible once saliva is passed over the surface. The coding system is also applicable in this stage and the traditional data is also applicable at some point in order to acquire good measurement. Horowitz, (2004), argues that this stage applied in measurement of caries is applied differently by different dentists and related individuals. The method is applied at a level where the lesions are not yet fully advanced and can be studied to an advanced level. This greatly increases the knowledge that was there concerning lesions as they are studied over a period of time. The information collected over this period of time is compared against other studies and then conclusions are deducted from the facts collected. It was noted that the lesions keep changing over time and that during the short periods of study a lot of change had taken place. In Australia, Horowitz, (2004) argues that this led to the introduction of the study of lesions over a long period of time in order to gain a certain form of pattern that can be used for study. This provides the clinical trials with a similar long term objective other than short term objectives that proved to be rather hectic. The use of technology in this measurement method has also come up quite a number of times as the benefits are likely to be profitable. This has been made possible by the use of devices that are aided by computers such as x- rays. These new methods have been seen to produce more accurate results making observation easier for the measurements to be conducted more accurately and effectively. Validity of the ICDAS The validation processes involves two main stages as well where the first one is the qualitative assignment. This is an experimental process where observation is the key concept. Hence, the qualitative stage ensures that the measures and definitions are suitable for the specific stage. According to Ismail et al (2007), based on the validity, the following concepts should be met; since tooth decay is a process, the process should also be measured and the stage only, the noncarious lesions are usually not detailed enough and this is well defined here and finally measuring the caries process involves use of words that require further definition and this process provides just that. The other process used for the validation section is the quantitative process which produces equally satisfying results. In general, ICDAS helps solve the problem in defining and understanding the infectious diseases and how it can be treated clinically. The measurement of dental caries is not a new process as it has been in practice for quite a long time. It is a process that is constantly repeated since the clinicians and other professionals never seem to come to a common agreement. However, ICDAS has helped calm the situation for a while as it has been able to provide reliable results. Advantages of the ICDAS The ICDAS is known to be highly reliable based on the results that it has been able to achieve over the years. The coding system has been very advantageous as it has made work much simpler for most clinicians. The criteria to be used are clearly defined and the terms are agreed on by most clinicians. The main problem with caries measurement has been the disagreement among the professionals since the measurement and defining of the condition proved to be quite difficult. The introduction of the codes helped solve the problem as they defined every tooth and lesion accordingly leading to more satisfactory results. However, there are still some disagreements that arise but they are much lesser. Decision making The ICDAS has played a big role in the decision making process for the clinicians. This is not an easy task as one has to be very careful in how they approach the issue of measure and the conclusions they get. The results that have been derived through the ICDAS process have been quite beneficial as they have helped improve the decision making routine. Dental detection According to Ismail, (2004), caries detection in Australia is one of the first processes usually applied. The process of detection might appear to be quite obvious according to study, but accuracy of the information being provided is very important. Here, the tooth surface is the main determinant of the existence of the caries. The original nature of the tooth surface is used to detect the presence of caries among other factors as well. The application of ICDAS has produces appropriate yet effective results through the course of time. This is important as it will show that the information collected is not biased and can be widely applied. The lesion measurements, which is the other process applied makes sure that all the stages are carefully looked at applied (Ismail, 2004). This is made possible by the application of the coding system used in ICDAS. Lesions may appear like they are easy to understand but recognizing them is not the main part but the knowledge of how each appears is what is of importance. Lesions are not always alike as they differ in terms of appearance and size as well. This makes them be categorized into different types. In this process a ‘diagnostic threshold’ is usually used to help define which surface has been attacked by caries and one which is normal. DMF (Decayed Missing Filled) Index The Decayed, Missing, Filled (DMF) index is another method that has been used to conduct the caries measurement process. This process has been used for quite while and it is a traditional method that is still being used (Broadment & Thompson, 2005). The fact that it has been used for the past fifty years and is still being used shows that it is well trusted. However, there have been several controversies based on the number of surfaces that are appropriate for a missing tooth. This revolves around the various procedures and preventive agents observed during dental practice. The fact that the research revolves around modern methods does not necessarily mean the current trends that evolve around technology and other related factors. This mainly refers to the new concepts that have been discovered with time and are not deployed in the caries clinical trials (CCT). According to the DMF index of all the measurements conducted, the caries activity has not been conducted well and the performance is rated as very poor (Horowitz, 2004). Clinicians who are responsible for conducting these measurements should be able to use appropriate methods that will enable them to study the lesions properly. Every individual lesion should be studied according to the present changes but not based on the traditional facts. Since these studies have been conducted before the progress that was observed to be made by the lesions in the historical time is still being used to date. Although study has shown that the lesions progress in a certain manner, current clinicians should also conduct their own measurements appropriately. Hence, these measurements are still under development in order to improve the process. Research has been conducted that shows that the methodology applied in caries measurement are rather very common and have reached a point of no development (Broadment & Thompson, 2005). The application of the new concepts is being advised by various health departments as they might appear to be very useful as they are approved of by most bodies. They also aim to achieve the same objective, which is improving the modern clinical trials management process (Gericke et al, 2010). This method has been advantageous but like so many others there have been several complaints. The arguments are mainly based on the number of surfaces to be allocated too various teeth. This problem is solved by allocating the required number of surfaces on a tooth by conducting various calculations. Problems faced by DMF Decay Missing Filled (DMF) can also be referred to as DMFST (Decay Missing Filling Surface Tooth). This system has been in use for quite a long time despite the fact that there have been many complaints. The results that are achieved by this measurement have been quite controversial stirring up a lot of arguments and many clinicians have fighting for its replacement. When using DMFS the missing tooth posses a problem for the clinicians during the trials as it is difficult to correctly allocate the surfaces on the missing tooth. This problem is however is not present when using the DMFT, although it is concluded that the missing teeth are said to have the most lesions. There have various methods proposed on how to deal with the M issue and the defining the surfaces. Not including the surfaces on the missing tooth has been suggested and they would be ignored as if the affected tooth was not present to begin with. The longitudinal study was suggested as well where the M in DMFS index can be given the same number of surfaces as had been recorded before the tooth went missing (DM2FS). Another alternative method would be to allocate the tooth three surfaces for each one that had been extracted or were filled during the trials. Comparison between Australia and Saudi Arabia As Huysmans, (2004) reports, dental caries is a major problem in Australia according to the dental records shown. This fact is attributed to the fact that the water supply in the country is highly fluoridated (Riordan, 2010). Presence of fluorine may tend to affect the enamel of the teeth leading to demineralization. Although the water is not the only causative agent as there is high use of fluoride toothpaste in the country. Though fluoride is a major contributor, it is not the only reason why dental caries is very common in the country. Lack of a healthy diet is also quite common since the children are easily affected by the disease at an early age. In the country, Huysmans, (2004) says that there is a particular region that has constantly resisted the supply of fluorinated water. The area is known as Perth and the cases of dental caries have proven to be lower than the other parts of Western Australia (WA). Saudi Arabia has a reputation of promoting oral health and this has led to the emergence of many oral health programs, which have been formed by Dental Directorate, Ministry of Health of Saudi Arabia. The programs were spearheaded in 2005 after survey results showed children were most affected by dental caries in the country. The programs aim at promoting oral hygiene especially among the children since this area had been neglected for quite a long while. The programs were bound to be very successful as they were launched mainly school. The relationship between teachers and the students had a good effect on the project as the children became more aware of dental caries. These programs include; the National Oral Health program for primary school children, Ante-natal Preventive Dentistry Program, Oral health Program for Pre-school Children, Health Tents Campaign, among others. Australia has quite created awareness among the children but the impact has not been as the one in Saudi Arabia. The adults are taking responsibility of taking care of the children’s’ teeth in Australia but given the correct approach children can take responsibility of their own teeth as well. Though cases of caries are there in Australia, observing another country such as Saudi Arabia, one realizes that cases of dental caries are in existent but are not as high as in Australia (Huysmans, 2004). The country mainly depends on well water hence, it is not fluoridated. Instead of consuming fluoridated water, the citizens of Saudi Arabia consume fluoridated salt. This is quite healthy as it does not lead to dental caries and it is used in iodized salt. Other causative agents include the abuse of drugs and lack of a healthy diet. Conclusion According to Huysmans, (2004), the information that has been collected in Australia over the years concerning caries measurements and management carefully reviewed and the success is deliberated. This is mainly done by parties that are affected by the study in any manner and they include, dentists, the government among others. This gives the clinicians conducting the trials an opportunity to prove their study and it is motivation as well. The incorporation of the modern methods in the Australian study has proven to be quite beneficial in that the results achieved have been accurate and more effective (Huysmans, 2004). This has also made work quite easier for the clinicians as the processes have been much simpler and less straining. Hence, the use of modern methods is being encouraged since some of the historical methods are not very effective. Reference List Broadment, J. , & Thompson, W. (2005). 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