Decline In Caries Research Articles

Decline in dental caries and public oral health care of adolescents

The adequacy and appropriateness of the oral health service were evaluated from patient records of 15-year-olds in Helsinki in 1976 and 1986. The subjects selected for the study represented the whole age group participating in public oral health service in the 2 years in question. During the 10 years, substantial decreases were seen in the mean numbers of dental visits (from 4.0 to 2.4) and fillings (from 2.9 to 1.2). The greatest decrease was seen in the number of fillings made in incisors. Slightly fewer preventive measures were carried out in 1986 than 10 years earlier, but no focusing on risk patients was seen. In the 2 years studied, 15-year-olds in the high-risk group received applications of topical fluorides and instructions on oral hygiene as often as those in the low-risk group. A major problem seemed to be the increasing number of unfinished courses of treatment among high-risk patients. We conclude that patients with a higher risk of caries should receive more attention with regard to both the preventive treatment given and ways of motivating them to complete their treatment courses.

Recent Trends in Dental Caries in U.S. Children and the Effect of Water Fluoridation

The decline in dental caries in U.S. schoolchildren, first observed nationwide in 1979-1980, was confirmed further by a second national epidemiological survey completed in 1987. Mean DMFS scores in persons aged 5-17 years had decreased about 36% during the interval, and, in 1987, approximately 50% of children were caries-free in the permanent dentition. Children who had always been exposed to community water fluoridation had mean DMFS scores about 18% lower than those who had never lived in fluoridated communities. When some of the "background" effect of topical fluoride was controlled, this difference increased to 25%. The results suggest that water fluoridation has played a dominant role in the decline in caries and must continue to be a major prevention methodology.

Fluoride in Caries Prevention: Is the Effect Pre- or Post-eruptive?

A longitudinal study of children from ages 7 to 18 showed that, if enamel lesions were included, the overall number was the same in fluoridated and non-fluoridated areas. However, a significant reducing effect of pre-eruptive fluoride could be seen in the number of dentinal lesions in a fluoridated area, provided that fluoride was also consumed post-eruptively for a considerable period of time. A precise estimation of both pre- and post-eruptive effects was obtained when teeth were classified according to their eruption time as related to the onset of water fluoridation. About 66% of the greatest reduction in pit and fissure caries came from pre-eruptive fluoride, while in smooth surfaces, this effect was reduced to 25%. In approximal surfaces, the reduction was due half to pre- and half to post-eruptive fluoride. Post-eruptive fluoride became more important with decreasing severity of caries attack. Thus, assuming a continuing decline in dental caries, the majority of such populations will benefit most from the use of topical fluorides. However, in high-risk groups, supplementation of pre-eruptive fluoride can still be of major importance.

Dental Caries Changes in the Scottish Isle of Lewis

The Scottish Isle of Lewis has an island community which traditionally is a stable population that has little migration of its school children. The island has low levels of fluoride (less than 0.1 ppm) in the drinking water supplies, but the island inhabitants have the availability of all UK commodities. The island has well detailed dental data going back to 1937. The present study (1987) examined dental caries and oral hygiene status in the school community between 1984 and 87 and compares the findings to the previous examinations completed by the same survey team. The caries levels declined during the period 1984-87, but not as rapidly as the decline reported in the 1970s. The main reason for the continued decline in dental caries appears to be the availability of fluoride dentifrices.

Epidemiology of dental caries

The most recent epidemiological data on the prevalence of dental caries in children indicate a halting of the increasing levels in many developing countries and a continuing decrease in many highly industrialized countries of the world. However, a further fall in caries levels predicted for 5-yr-old children in the U.K. has not occurred and the decline in caries may have begun to level out. ‘Polarization’ of caries to a minority of high-risk individuals is occurring in the developed world, with 20–25% of children accounting for more than 50% of the disease. Socio-economic factors are important in determining the proportion of high-risk children in these countries. The multifactorial aetiology of caries allows a number of different interpretations to account for changes in the prevalence of the disease with time, in both the developing and developed countries. These changes are variously ascribed to alterations in dietary habits, especially the consumption of sugar; variations in the patterns of oral hygiene; increased contact with trace elements, especially fluoride, in the environment; changes in the ecology and/or virulence of oral and dental plaque microflora and alterations in the oral protective mechanisms including the immune status. The epidemiological evidence available on the relationship of all these social, environmental and other factors to changes in the prevalence levels of caries does not, however, fully explain all the changes that have been observed. The claim that caries is no longer a public health problem is premature, as it ignores the still high proportion of individuals with tooth decay throughout the world.

Issues in the economic evaluation of community water fluoridation

Community water fluoridation has long been recognized as an effective public health intervention in the prevention of dental caries. The recently documented secular decline in dental caries, however, presents for policy makers the challenge of appropriately allocating limited health care resources between a variety of health care programs. Appropriate economic assessment of these alternatives becomes critical for rational distribution of such resources. Cost-benefit and cost-effectiveness analyses are techniques that, when used correctly, can guide policy makers facing such decisions. This paper reviews and critiques the published literature assessing the cost effectiveness and cost benefit of community water fluoridation using criteria developed for economic evaluation. Eight papers met the criteria for inclusion in the present study. In general, the articles failed to incorporate the declining prevalence of dental caries into their analyses and to fully document costs associated with water fluoridation. Treatment savings from dental care averted secondary to water fluoridation were not appropriately incorporated into the cost-effectiveness analyses, thereby overestimating the marginal cost associated with fluoridation. Specification of outcome measures to assess the consequences of water fluoridation failed to incorporate the dynamic nature of dental disease. Suggestions for improving the generalizability and usefulness of future cost-benefit and cost-effectiveness analyses are made.

Declining dental caries in Jerusalem schoolchildren.

There has been an increase of dental caries in Israel during the last decade (1970-80), while most developed industrialized countries reported a decline in dental caries since 1970. A survey carried out on 267 first graders (6 yr old) by the same investigator and with the same methods as in the previous survey (1977), showed a significant decrease in prevalence of dental caries in 1985 as follows: 78% affected children with a caries score of 4.9 compared to 86.2% with a caries score of 5.2 in 1977.

Possible effect of medically administered antibiotics on the mutans streptococci: implications for reduction in decay.

The decline in dental caries in children in North America, Scandinavia, Britain, Ireland and many Commonwealth nations is well documented. The multiple uses of fluoride can account for most, but not all, of this reduction. In this investigation, data are provided which suggest a relationship between antibiotic usage for medical purposes and a decline in both mutans streptococci (MS) and caries. Children attending Grades 1 and 2 in the Coldwater, Michigan school system and who reportedly never received antibiotics had significantly higher proportions of MS in the fissure plaques of first molars than subjects who received antibiotics. The level of decay in the primary dentition was inversely related to the reported usage of antibiotics. The frequent usage of antibiotics could reduce the incidence of dental caries by delaying the colonization of the teeth by the MS. This was evaluated by a prospective study in infants to determine what effect reported antibiotic usage would have on the colonization of newly erupting primary teeth. Only 2 of 10 infants cultured at 2 to 3 week intervals for periods up to 1 year after tooth eruption became colonized by the MS. One had never received antibiotics and the second had been on antibiotics for a single 5-day period. Seven of the 8 non-colonized infants had received antibiotic therapy for periods ranging from 10 to 181 days. Both the Coldwater study and the prospective study of infants suggested a relation between frequency of antibiotic usage for medical purposes and the MS levels on the teeth.

Forty years of progress.

The celebration of the 40th anniversary of the National Institute of Dental Research (NIDR) provides an opportunity for reviewing the growth of dental research over the decades. The Institute owes its origin to public and professional concern over the dental health of Americans and the prospect that a Federal investment in dental research could pay off. The early years of the Institute were devoted to studies of fluoride and dental caries, with notable achievements in clinical trials of water fluoridation and caries microbiology. During the 1960s came the discovery that the periodontal diseases, like dental caries, were bacterial infections that could be prevented. Basic and clinical research expanded, and the research manpower pool grew with the addition of microbiologists, immunologists, salivary gland investigators, and other basic biomedical and behavioral scientists. The Institute created special broad-based Dental Research Institutes and Centers to foster interdisciplinary research, and continued to expand its research base. A national survey undertaken by NIDR in the late 1970s showed major declines in caries prevalence in schoolchildren. Recent NIDR surveys of adults and older Americans as well as a second children's survey have demonstrated overall improvements in oral health and a continued decline in childhood caries.(ABSTRACT TRUNCATED AT 250 WORDS)

Dental health of children in Australia, 1977-1985.

AbstractDental caries and oral hygiene indices for school children aged four to 13 years have been determined each year since 1977. This report is based on 6 228 972 examinations. For children aged six to 13 years the mean DIMF indices declined by 59.3 per cent. For 12‐year‐old children the mean DIMF indices declined from 4.79 in 1977 to 2.13 in 1985; it is calculated that the DIMF index for this age group will be 1.5 in 1991. While a major decline in dental caries has been observed, a significant proportion of children continue to have a caries problem. Girls of all ages had lower mean oral hygiene indices than boys; the index for girls and boys combined declined by 26 per cent in the period 1977 to 1985.

某高等専門学校の１９７５年〜１９８７年度学生におけるう蝕有病状況

In order to examine the reduction of dental caries in Japanese adolescents, 1368 male students aged 15 to 19 years were examined from 1975 to 1987. Because an irregular yearly variation in caries prevalence among the same age groups was observed, the method of 3-year moving average was used and statistically analyzed on a linear regression. From the yearly trend in the same age groups, peaks were shown in the mean DMFT of students 15 to 17 years of age in 1979 to 1981 and in the mean DMFS of students 15 to 19 years of age in 1979 to 1983. After the peaks, a statistically significant decrease in caries prevalence was found in the mean DMFT of students 15 years of age and in the mean DMFS of students 15 and 17 years of age. It is therefore concluded that a decline in dental caries in Japanese adolescents is clear and will be more evident in the near future.

Has the decline of dental caries in English children made water fluoridation both unnecessary and uneconomic?

Has the decline of dental caries in English children made water fluoridation both unnecessary and uneconomic?

Changes in oral health from 1973 to 1982 of 13-15-year-old schoolchildren residing in three different fluoride areas in Finland.

The aim of the present study was to analyze the change from 1973 to 1982 in the oral health conditions of 13-, 14-, and 15-year-old school-children residing in three different fluoride areas in Finland. Oral hygiene, as measured with the Visible Plaque Index (Ainamo and Bay, 1975), had improved significantly both among 13-year-old girls (P less than 0.01) and among boys of the same age (P less than 0.05). A highly significant improvement (P less than 0.001) of gingival health, as measured with the Gingival Bleeding Index (Ainamo and Bay, 1975), was observed for boys but not for girls. The striking change was for the DFST (T = total) and FSAA (A = approximal) scores for the totals of 180 girls and 180 boys. This improvement in dental health was mainly due to a dramatic decline of caries in the low-fluoride (0.2 ppm F) area, whereas in the high-fluoride area (2.5 ppm F), the improvement in oral hygiene and gingival health was the greatest. The results support earlier assumptions that caries and gingivitis are separate and mutually independent disease entities. The study further suggests that local fluoride treatments can provide caries-preventive benefits similar to those achieved by community water fluoridation, although at greater cost. The comparison in time revealed that most of the differences in oral health, observed in 1973 both between sexes and between the different fluoride areas, had disappeared by the time of the 1982 examination.

Effect of Secular Decline in Caries on the Evaluation of Preventive Dentistry Demonstrations*

Studies of dental preventive interventions often do not incorporate a concurrent, longitudinal control group in their study design. The existence of a secular decline in dental caries during the conduct of these studies may result in an overstatement of the effectiveness of the preventive intervention. Results of a recent large caries preventive study are analyzed using both a concurrent, longitudinal control group and an historical comparison group to demonstrate this effect. Differences in effectiveness of preventive procedures determined using the two types of control groups are sufficient to suggest a probable misinterpretation of results of studies using only historical comparisons.

Gerodontology: 'long in tooth' but not short of dental care

Gerodontology—the study of the dentition and dental problems of elderly persons—has joined geriatrics and gerontology as a growing health care specialty. Faced with the combination of a decline in dental caries among younger persons and an increasing number of aging patients who have not, as a recent issue (Jan 10) ofHarvard Medical Area Focusputs it, had the benefits of improved dental techniques, oral hygiene, and fluoride treatment that began to enhance dental health in the 1960s, many schools are preparing students to turn their attention to those older patients who have still managed to keep some of their teeth. According to Ronald L. Ettinger, DDS, Iowa City, Iowa, president of the American Society for Geriatric Dentistry, about 12% of the 60 dental schools in this country accredited by the American Dental Association offer a truly comprehensive course in geriatric care. This bears out the results of a survey

Changing trends in dental caries.

In underdeveloped countries the number of dental caries is increasing at a frightening rate whereas in industrialized countries the caries rate has declined by about 40% in the past 10 years. In 1982, for the first time ever, the average 12-year-old in underdeveloped countries, where 80% of the world's children live, had a higher dental caries score (decayed, missing, filled-DMF) than those in industrialized countries. The increase in caries is associated with increases in sugar consumption. By 1984, sugar consumption in underdeveloped countries is predicted to exceed that of industrialized countries. The decline in caries is associated with the widespread availability of fluoride toothpaste, changes in the pattern and quantity of sugar consumption and possibly with the frequent use of antibiotics. The declines have been greater in areas with fluoridated water supplies. The trends in rates of dental caries have important public health implications. They include the urgent need for a food policy to limit the consumption of refined sugars, policies to ensure the availability of fluoride, a reduction in the number of dentists in industrialized countries, the greater use of dental therapists and increasing the interval between dental check-ups to two years or more.