**3.1.1 DMFS index**

The DMFT index was developed by Klein, Palmer and Knutson during a study of the dental condition and the need of children's treatment in elementary schools in Hagerstown, Maryland, USA, in 1935. It has been the most important index in the dental researches to quantify the prevalence of tooth decay (Katz et.al., 1997).

The caries experience (past and present) indicates the teeth damages and treatments received before by the count of teeth decays or natural history of the dental caries, which it expresses as decayed, missing and filled teeth (DMFT index) or decayed, missing and filled surfaces (DMFS index), both indexes express numerically the caries prevalence. The sum of these three points is the index (Sánchez & Sáenz, 1998; World Health Organization [WHO], 1997; WHO, 2011b).

For better analysis and interpretation it will be separate in each component and express it by percentage or mean. This is important to compare populations.

To obtain DMFT index in population, WHO recommended the next age groups: 5-6, 12, 15, 18, 35-44, 60-74 years. The index at 12 age is used to compare the oral health between countries.

Clinical, Salivary and Bacterial Markers on the Orthodontic Treatment 159

6: is assigned to teeth on which sealants have been placed. Teeth on which the occlusal

7: is used to indicate that the tooth is part of a fixed bridge. When a tooth has been crowned for a reason other than decay, this code is also used. Teeth that have veneers or laminates covering the facial surface are also termed 7 when there is no evidence of caries or restoration. A 7 is also used to indicate a root replaced by an implant. Teeth that have been

8: this code is used for a space with an unerupted permanent tooth where no primary tooth

9: Erupted teeth that cannot be examined—because of orthodontic bands, for example—are

The "D" of DMFT refers to all teeth with codes 1 and 2. The "M" applies to teeth scored 4 in subjects under age 30, and teeth scored 4 or 5 in subjects over age 30. The "F" refers to teeth

The dental plaque represents a bacterial structure formed in the surfaces of the teeth that cannot be eliminated by water, which contains great number of microorganisms grouped

It has two phases related between them: inner one, with the enamel, where they find salivary free components of cells forming a cuticle or cap named biofilm and another in contact with the oral cavity, named interface plaque - saliva. If a tooth is cleaned deeply, exposing the enamel to the oral environment, in less than one hour this one would remain covered by the biofilm, whereas the initial formation of the dental plaque can need up to

and surrounded with extracellular materials from bacterial and salivary origin.

two hours. (Harris & García-Godoy, 2001; Menaker et al., 1986)

with code 3. Those teeth coded 6, 7, 8, 9, or T are not included in DMFT calculations.

fissure has been enlarged and a composite material placed should also be termed 6.

replaced by bridge pontics are scored 4 or 5; their roots are scored 9.

is present. The category does not include missing teeth.

scored a 9.

The parameters to reference are:

Fig. 1. Obtained DMFS index.

**3.1.2 Supragingival plaque** 

Low 1 to 3 caries lesions Moderate 4 to 6 caries lesions High 7 to 9 caries lesions

Higher 10 or mores caries lesions (Fig. 1).

The scientific evidences suggest that this is the most sensitive indicator to predict future risk, since if a subject does not establish the biochemical balance between demineralizationremineralization it will develop more caries lesions.

World Health Organization clearly established the methodology to obtain the index in the Oral Health Surveys. As increase the lesions number, increases the risk to develop caries, even in filled teeth (WHO, 1997).

The subjects are examined in the clinic area with the aid of a dental mouth mirror and periodontal probe, type E. The presence of caries was recorded using WHO's DMFS criteria.


For permanent dentition use the next codes:

0: showing no evidence of either treated or untreated caries. A crown may have defects and still be recorded as 0. Defects that can be disregarded include white spots; discolored or rough spots that are not soft; stained enamel pits or fissures; dark, shiny, hard, pitted areas of moderate to severe fluorosis; or abraded areas.

1: indicates a tooth with caries. A tooth or root with a definite cavity, undermined enamel, or detectably softened or leathery area of enamel or cementum can be designated a 1. A tooth with a temporary filling, and teeth that are sealed but decayed, are also termed 1.

2: Filled teeth, with additional decay. No distinction is made between primary caries which is not associated with a previous filling, and secondary caries, adjacent to an existing restoration.

3: indicates a filled tooth with no decay. If a tooth has been crowned because of previous decay, that tooth is judged a 3. When a tooth has been crowned for another reason such as aesthetics or for use as a bridge abutment, a 7 is used.

4: indicates a tooth that is missing as a result of caries. When primary teeth are missing, the score should be used only if the tooth is missing prematurely. Primary teeth missing because of normal exfoliation need no recording.

5: a permanent tooth missing for any other reason than decay is given a 5. Examples are teeth extracted for orthodontics or periodontal disease, teeth that are congenitally missing, or teeth missing by trauma.

6: is assigned to teeth on which sealants have been placed. Teeth on which the occlusal fissure has been enlarged and a composite material placed should also be termed 6.

7: is used to indicate that the tooth is part of a fixed bridge. When a tooth has been crowned for a reason other than decay, this code is also used. Teeth that have veneers or laminates covering the facial surface are also termed 7 when there is no evidence of caries or restoration. A 7 is also used to indicate a root replaced by an implant. Teeth that have been replaced by bridge pontics are scored 4 or 5; their roots are scored 9.

8: this code is used for a space with an unerupted permanent tooth where no primary tooth is present. The category does not include missing teeth.

9: Erupted teeth that cannot be examined—because of orthodontic bands, for example—are scored a 9.

The "D" of DMFT refers to all teeth with codes 1 and 2. The "M" applies to teeth scored 4 in subjects under age 30, and teeth scored 4 or 5 in subjects over age 30. The "F" refers to teeth with code 3. Those teeth coded 6, 7, 8, 9, or T are not included in DMFT calculations.

The parameters to reference are:

158 Contemporary Approach to Dental Caries

The scientific evidences suggest that this is the most sensitive indicator to predict future risk, since if a subject does not establish the biochemical balance between demineralization-

World Health Organization clearly established the methodology to obtain the index in the Oral Health Surveys. As increase the lesions number, increases the risk to develop caries,

The subjects are examined in the clinic area with the aid of a dental mouth mirror and periodontal probe, type E. The presence of caries was recorded using WHO's DMFS criteria.

**Codes Condicion**  0 Health 1 Decayed 2 Filled with caries 3 Filled without caries 4 Missing by caries 5 Missing by other reason 6 Sealant, coat 7 Bridge or crown 8 Non eruption 9 Exclude 0: showing no evidence of either treated or untreated caries. A crown may have defects and still be recorded as 0. Defects that can be disregarded include white spots; discolored or rough spots that are not soft; stained enamel pits or fissures; dark, shiny, hard, pitted areas

1: indicates a tooth with caries. A tooth or root with a definite cavity, undermined enamel, or detectably softened or leathery area of enamel or cementum can be designated a 1. A tooth with a temporary filling, and teeth that are sealed but decayed, are also termed 1.

2: Filled teeth, with additional decay. No distinction is made between primary caries which is not associated with a previous filling, and secondary caries, adjacent to an existing restoration. 3: indicates a filled tooth with no decay. If a tooth has been crowned because of previous decay, that tooth is judged a 3. When a tooth has been crowned for another reason such as

4: indicates a tooth that is missing as a result of caries. When primary teeth are missing, the score should be used only if the tooth is missing prematurely. Primary teeth missing

5: a permanent tooth missing for any other reason than decay is given a 5. Examples are teeth extracted for orthodontics or periodontal disease, teeth that are congenitally missing,

remineralization it will develop more caries lesions.

even in filled teeth (WHO, 1997).

For permanent dentition use the next codes:

of moderate to severe fluorosis; or abraded areas.

aesthetics or for use as a bridge abutment, a 7 is used.

because of normal exfoliation need no recording.

or teeth missing by trauma.


Fig. 1. Obtained DMFS index.

### **3.1.2 Supragingival plaque**

The dental plaque represents a bacterial structure formed in the surfaces of the teeth that cannot be eliminated by water, which contains great number of microorganisms grouped and surrounded with extracellular materials from bacterial and salivary origin.

It has two phases related between them: inner one, with the enamel, where they find salivary free components of cells forming a cuticle or cap named biofilm and another in contact with the oral cavity, named interface plaque - saliva. If a tooth is cleaned deeply, exposing the enamel to the oral environment, in less than one hour this one would remain covered by the biofilm, whereas the initial formation of the dental plaque can need up to two hours. (Harris & García-Godoy, 2001; Menaker et al., 1986)

Clinical, Salivary and Bacterial Markers on the Orthodontic Treatment 161

2. Functions related to the mastication and the speech (food preparation by the digestion,

To evaluate the quantity of production as well as his functions helps us to determine factors

The average of total saliva flow is 0.3 to 0.4 ml/min in adults, exist approximately a saliva secretion of 1500 ml/24 hrs. This rate of unstimulated saliva flow is based to a circadian rhythm, with a major flow in the middle of the evening and minor about 4 a.m. The flow changes considerably in persons who are resting. During sleep, the flow is very low or non-

An unstimulated salivary <0.30 mL/min it is considered like risk factor (Ansai et al., 1994; Harris & García-Godoy, 2001; Fenoll-Palomares et al., 2004; Larmas, 1992; Leone, 2001;

All salivary components neutralize the acids produced by cariogenic bacterias. For this reason the saliva production is important to support the oral health. Any agent or condition

One way to measure this is by the formation time (in seconds) of small saliva drops in the inner mucous of the lower lip and compared with a chart. (Saliva Check®1) (Varma et al.,

Physiologically the stimulus can be mechanic as mastication. It can be gustatory as result of the stimulation of the gustatory or psychological papilla on having imagined the favorite food. Inversely, it can diminish with fear, radiation causing destruction of the salivary

existent and increases during the day, especially with the food ingestion.

that reduces the quantity of saliva increases the risk of dental decay.

Fig. 3. Unstimulated saliva flow measured by Kit Saliva Check.

1 Saliva Check®, GC America Inc., Alsip, IL, USA.

flavor and phonation) (Kaufman & Lamster, 2000).

of the guest in the development of dental decay.

Low greater than 60 seconds

Normal 30 a 60 seconds High less than30 seconds

**3.2.2 Stimulated saliva** 

**3.2.1 Unstimulated saliva** 

Zárate et al., 2004).

2008) (Fig. 3)

The principal diseases originated by dental plaque are caries and periodontal diseases, they originate in sites where the dental plaque is more abundant and is stagnant.

A number of plaque indices have been developed for assessing individual levels of plaque control and are also have been used in several epidemiological studies. Some of the most well - known indices, which have been used in numerous studies, are listed below:


The plaque control record evaluating the presence of soft debris on the tooth surfaces and dentogingival junction, as well as toothbrushing efficacy. (Butler et al., 1996; O'Leary et al., 1972).

According to O'Leary index, plaque is disclosed with a chewable tablet and its amount estimated. To determine an individual's score, the clinician multiplies the number of surfaces with plaque by 100, and divides that by the number of tooth surfaces examined. (WHO, 2011a) (Fig. 2).

Fig. 2. Plaque control record.

#### **3.2 Salivary markers**

Saliva is a fluid present in mouth that comes from major and minor glands. Saliva is essential for the protection of the tooth against dental caries and protects the integrity of the soft oral tissues, facilitates the mastication, the swallowing and the speech, as well as the sensibility and the digestive functions in the oral cavity. Near 99 % of saliva is water, 1% remaining consists of a complex mixture of constituent to different concentrations (Harris & García Godoy, 2001; Featherstone, 2000; Fenoll-Palomares et al., 2004; Larmas, 1992; Leone, 2001).

The principal functions of the saliva are:

1. Protection functions (lubrication, preserve the integrity of the oral mucous, cleanliness, buffer capacity, dental remineralization and antimicrobial).

2. Functions related to the mastication and the speech (food preparation by the digestion, flavor and phonation) (Kaufman & Lamster, 2000).

To evaluate the quantity of production as well as his functions helps us to determine factors of the guest in the development of dental decay.
