1. Kevin J. Hale, DDS, FAAPD Founding Director, Points of Light project

2. Presentation Goals: Brief Review of Cariology: Microbial Ecology Epigenetic Theory Intergenerational Aspects of Cariology Implications for Prevention “Good doctors treat disease, Great doctors prevent disease”

3. A Brief Review of Cariology

4. 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

5. Def: Classical vs. Non-classical infectious disease

6. Incidence of Caries in 35 yr. olds: NHanes DMFS Population 20%

7. Make up of Normal Oral Flora Total: 1000 Benign 800 Periodontal 150 Aciduric 50

8. Bacterial Guts & Stuff! Sugar Lactic Acid EM H+H+ ATP ADP OH - F-ATPase

9. 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.

10. Constitutional vs. Adaptive (epi-genetic) Virulence

12. 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….

13. 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.

14. Management of Oral Flora

15. Benign Floral Enhancement : Removal of Decay Modification of Diet Smoking Cessation Optimization of Oral Hygiene Judicious Administration of Fluoride Utilization of Xylitol

16. General Oral Hygiene Assessment No Inflammation Inflammation No PlaquePlaque ComplianceDiet Performance Brushing Non- Compliance

20. Putting the pieces together!

21. 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.

22. “ 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?

23. 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.

24. Identify those at risk and refer to a dentist.

26. 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.

27. Points-of-light.org