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**5** 

*USA* 

David Todem

**Statistical Models for Dental Caries Data** 

*Division of Biostatistics, Department of Epidemiology and Biostatistics,* 

Tooth decay is ubiquitous among humans and is one of the most prevalent oral diseases. Although this condition is largely preventable, more than half of all adults over the age of eighteen present early signs of the disease, and at some point in life about three out of four adults will develop the disease. Tooth decay is also common among children as young as five and remains the most common chronic disease of children aged five to seventeen years. It is estimated that tooth decay is four times more prevalent than asthma in childhood (Todem, 2008). Tooth decay and its correlates such as poor oral health place an enormous burden on the society. Poor oral health and a propensity to dental caries have been related to decreased school performance, poor social relationships and less success later in life. It is estimated that about 51 million school hours per year are lost in the U.S. alone because of dental-related illness. In older adults, tooth decay is one of the leading causes of tooth loss which has a dramatic impact on chewing ability leading to detrimental changes in food selection. This, in turn, may increase the risk of systemic diseases such as cardiovascular

The etiology of dental caries is well established. It is a localized, progressive demineralization of the hard tissues of the crown and root surfaces of teeth. The demineralization is caused by acids produced by bacteria, particularly mutans Streptococci and possibly Lactobacilli, that ferment dietary carbohydrates. This occurs within a bacteria-laden gelatinous material called dental plaque that adheres to tooth surfaces and becomes colonized by bacteria. Thus, dental caries results from the interplay of three main factors over time: dietary carbohydrates, cariogenic bacteria within dental plaque, and susceptible hard tooth surfaces. Dental caries is also a dynamic process since periods of demineralization alternate with periods of remineralization through the action of fluoride,

The evaluation of the severity of tooth decay is often performed at the tooth surface level. According to the World Health Organization, both the shape and the depth of a carious lesion at the tooth surface level can be scored on a four-point scale, D1 to D4. Level D1 refers to clinically detectable enamel lesions with non-cavitated surfaces; D2 for clinically detectable cavities limited to the enamel; D3 for clinically detectable lesions in dentin; and finally D4 for lesions into the pulp. Despite these detailed tooth-level data, most epidemiological studies often rely on the decayed, missing and filled (DMF) index,

**1. Introduction** 

diseases and cancer.

calcium and phosphorous contained in oral fluids.

*Michigan State University, East Lansing, MI,* 

