Declining Caries Trends: Are We Satisfied?

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Abstract

WHO data suggest that all over the world the prevalence of caries has declined at the end of the previous and in the first decade of the present century. This decline started wherever the use of effective fluoride toothpaste became commonplace. Even though the decline is considerable with a 90 % reduction in DMFT for 12-year-olds in Western Europe and the USA, caries still affects 60-90 % of the children throughout the world. In the high- and middle-income countries, the nature of caries has changed from a rapid progressing disease of childhood to a slowly progressing disease throughout adulthood and even old age. However, throughout the world, the circumstances for caries differ, e.g., low-income countries experience more caries with higher sugar consumption, while between high-income countries this correlation is reversed. In high-income countries, fluoride is widely used and preventive programs in dental offices are in place. These programs, if effective, may not be a realistic option in low-income countries. In order to reduce caries in the world even further, the use of effective and affordable fluoride toothpaste should be encouraged and enabled.

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Most cited references 29

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Changes in dental caries 1953-2003.

T M Marthaler (2004)

In the first half of the 20th century, indices and methods of conducting surveys of the level of dental diseases were developed. Modern epidemiological studies began in the fifties and many reliable studies have been conducted after 1960. In the following decades, a substantial decline of caries prevalence was documented in the majority of the highly industrialized countries, with reductions of lifetime caries experience exceeding 75%. The decline comes to an end when low or very low levels of prevalence are reached. Children of low socioeconomic status and immigrants from outside Western Europe, however, generally have higher disease levels and may cause increases in caries prevalence. For this and other reasons, caries epidemiology will remain an indispensable part of dental public health. Copyright 2004 S. Karger AG, Basel

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Reasons for the caries decline: what do the experts believe?

H Sundberg, D Bratthall, G Hänsel Petersson (1996)

The aim of this paper was to describe what experts of today believe are the main reasons explaining the caries decline seen in many westernized countries over the past 3 decades. We have collected the views of a number of international experts, trying to answer the specific question "What are the main reasons why 20-25-year-old persons have less caries nowadays, compared to 30 years ago?". A questionnaire was mailed to 55 experts with a number of thinkable explanations to be scored according to a predetermined scale. The 25 items were divided into main groups under the heading of diet, fluorides, plaque, saliva, dentist/dental materials and other factors. The experts were asked to think of a specific country or area, and also to specify whether the chosen area had water fluoridation or not. The main finding of our study, based on a 95% response rate, was that there is a very large variation in how the experts graded the impact of various possible factors. For the use of fluoride toothpaste, there was a clear agreement of a definite positive effect.

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The common risk factor approach: a rational basis for promoting oral health.

R Watt, A. Sheiham (2000)

Conventional oral health education is not effective nor efficient. Many oral health programmes are developed and implemented in isolation from other health programmes. This often leads, at best to a duplication of effort, or worse, conflicting messages being delivered to the public. In addition, oral health programmes tend to concentrate on individual behaviour change and largely ignore the influence of socio-political factors as the key determinants of health. Based upon the general principles of health promotion this paper presents a rationale for an alternative approach for oral health policy. The common risk factor approach addresses risk factors common to many chronic conditions within the context of the wider socio-environmental milieu. Oral health is determined by diet, hygiene, smoking, alcohol use, stress and trauma. As these causes are common to a number of other chronic diseases, adopting a collaborative approach is more rational than one that is disease specific. The common risk factor approach can be implemented in a variety of ways. Food policy development and the Health Promoting Schools initiative are used as examples of effective ways of promoting oral health.