The anatomical site distribution of clinical dental caries in the mandibular incisor teeth of 11- and 12-Year-old children aetiological implications

Abstract

Selected aspects of the prevalence and the anatomical site-distribution of clinical dental caries in the mandibular incisor teeth of 11- and 12-year-old children are described. Data were obtained from two independent sources. The first source was an epidemiological study of 1246 boys and 1191 girls residing in the Leeds area. In this population the number of individuals with caries experience in mandibular incisors was 101 (approximately 4 per cent). The second source was a survey carried out by school dental officers in the North of England (excluding the Leeds area) who recorded the anatomical site distribution of caries attack in 108 twelve-year-old children with mandibular incisor caries. The site distribution of caries attack was similar in each survey and it was highly non-random. In the population the prevalence of attack on each right site was closely similar to that at its left homologue, but in individuals the number of asymmetrical attacks was either approximately equal to, or it was greater than, the number of symmetrical attacks. Again, in the population the prevalence of attack was approximately the same on each member of a pair of adjacent surfaces, but in individuals the number of “single attacks” (one surface only) was about the same as the number of “double attacks” (both surfaces). The possible aetiological and pathogenetic significance of the non-random distribution of dental caries in the population, and of the regularities in its anatomical site distribution in individuals, is discussed. Several possible hypotheses, based on traditional aetiological views, are considered, and they are shown to be inconsistent with the observations. It is concluded that the disturbed-tolerance autoimmune hypothesis of the aetiology and pathogenesis of dental caries provides a possible interpretation of the overall evidence.