Kevin J. Hale, DDS, FAAPD

Founding Director, Points of Light project

Presentation Goals:

Brief Review of Cariology:Microbial EcologyEpigenetic Theory

Intergenerational Aspects of CariologyImplications for Prevention

“Good doctors treat disease, Great doctors prevent disease”

A Brief Review of Cariology

Indigenous Oral Biota:

Species Specific: Dog bacteria live on dogs and people bacteria live on people.

Site Specific: Oral Flora is unique as compared to flora from skin, nasopharynx, etc…(Adaptive Degeneration)

Qualitatively Stable: Once established

Def: Classical vs.

Non-classical infectious disease

Incidence of Caries in 35 yr. olds: NHanes

DMFS

Population

20% 20%

Make up of Normal Oral Flora

Total: 1000

Benign 800

Periodontal 150

Aciduric 50

Bacterial Guts & Stuff!

Sugar

Lactic Acid

EM

H+

ATP ADP

OH-

F-ATPase

Caries

A progressive shift in sub-population ratios of established normal, oral flora and a predominance of aciduric/acidogenic flora eventually resulting in dental decay.

Constitutional vs.

Adaptive (epi-genetic) Virulence

Hypoplasia-Associated Severe Early Childhood Caries

Rising “epidemic” of caries correlated with rising number of children living in poverty.

Diet consists of mainly processed food high in sugar & low in protein.

Obesity is a form of malnutrition and maternal obesity is associated with ECC.

Effects Inner city, Native Americans, etc….

Perinatal Components of Severe ECC:

Perinatal stresses linked to enamel hypoplasia, (EHP).

Hypoplasia linked to early colonization & higher levels of mutans streptococci.

Linked to maternal malnutrition, smoking, liver disease, drug and alcohol use and other factors leading to prematurity.

Prematurity and low birthweight are major contributors to EHP.

Management of Oral Flora

Benign Floral Enhancement:

Removal of Decay

Modification of Diet

Smoking Cessation

Optimization of Oral Hygiene

Judicious Administration of Fluoride

Utilization of Xylitol

General Oral Hygiene Assessment

No Inflammation

Inflammation

No Plaque Plaque

Compliance Diet

Performance Brushing

Non-Compliance

Putting the pieces together!

Caries Risk Assessment:

Based on developmental, behavioral & environmental factors over time.

Evaluates the probability of caries progressing to decay.

Allows for tailoring of preventive strategies for an individual patient’s caries risk.

Improves oral health in a cost-effective manner.

Very much a work in progress.

“When the cliff is steep, don’t dance at the edge!”

Non-dental risk factors for Caries

Low SES

Behavioral Issues

Medical Condition

Very young Patients

What is the probability of a good outcome?

Redefining the Goal of Oral Health Management

Restoring teeth is only a part of our obligation to our patients.

We are rangers of the oral veldt.

Our goal is to establish and maintain oral microbio-diversity in our patients’ mouths.

In fact, waiting for teeth to decay is NOT an acceptable practice.

Ideally, all children would establish a Dental Home by one year of age.

Identify those at risk and refer to a dentist.

First Visit Recommendations:

American Dental Association, Academy of General Dentistry & American Academy of Pediatric Dentistry: 6 Months after the first tooth erupts and no later than 12 months of age.

American Academy of Pediatrics: As early as 7 months for infants deemed to be ‘At risk’ and no later than early toddler years.

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