Distribution Of Caries Research Articles

Why Is Caries Prevention in Children So Difficult? A Narrative Opinion.

Caries is among the most common non-communicable diseases worldwide, yet it is commonly described as preventable. Caries prevention is, however, difficult and complex, since the disease has strong social, parental, behavioral, political, medical/genetic, and psychological elements, and the payment models are targeted at traditional conservative care. The aim of this paper is to discuss some key issues that make caries prevention in children be perceived as "difficult": i) the communication gap between researchers and clinicians, creating unrealistic expectations of intervention efficacy; ii) the skewed distribution of caries and the problem of reaching children with the highest need; iii) limited access to care, which is a threat to oral health, in particular in low-socioeconomic-status, underserviced, and remote communities; and iv) the need to adopt behavior change models to affect the modifiable risk factors that are shared with other non-communicable diseases. Dentists cannot simply rely on fluoride exposure; proper education and training in caries risk assessment, behavior change models targeted at oral hygiene and sugar intake, and collaboration with primary healthcare and local school authorities are avenues that aid in caries prevention and reduce the uneven burden of the disease. Online education and mobile apps may help to promote oral health in areas with shortages of dental work force.

Determination of orthodontic anomaly patterns in patients in the Thrace region and assessment of the relationship between orthodontic anomalies and DMFT indices: a retrospective study

OBJECTIVE: The aim of this study was to investigate the prevalence of dental and skeletal anomalies that could be a cause of malocclusion and their relationship with caries distribution in the western region of Türkiye. MATERIALS AND METHOD: A retrospective study was conducted with 1815 digital panoramic and lateral cephalometric radiographs taken from patients, age ranging between 6 and 47 years, who applied for orthodontic treatment. The lateral cephalometric radiographs, panoramic radiographs, and dental records were reviewed according to skeletal anomaly, dental malocclusion (Angle classification), and decay-missing- filling teeth (DMFT) index. Kruskal Wallis test was used in intergroup comparisons of variables that did not show normal distribution, and Dunn’s multiple comparison test was used in subgroup comparisons. The chi-square test and Yates correction were used in comparisons of qualitative data. RESULTS: The mean DMFT of the dental Class I malocclusion group was statistically and significantly lower than Class II division 1 and Class III malocclusion groups (p < 0.05). The mean DMFT index of Class II subdivision malocclusion group was statistically and significantly lower than that of Class III malocclusion group (p < 0.05). The DMFT index was significantly lower in the skeletal Class I group compared to the skeletal Class II and Class III anomaly groups (p < 0.05). CONCLUSION: There is a correlation between DMFT indices and dental malocclusions as well as skeletal anomalies. By correcting dental malocclusions and skeletal anomalies with orthodontic treatment and providing ideal occlusion, it becomes easier for patients to maintain oral hygiene and DMFT indices might decrease.

Prevalence of dental caries among children and adolescents with intellectual disability in India: A scoping review.

Children with intellectual and developmental disabilities are at a higher risk of developing dental caries. Few scoping reviews have been conducted in India to understand their issues. We aimed to summarise the distribution and risk factors of dental caries among children and adolescents with intellectual disabilities in India. A scoping review was conducted based on the Arksey O Malley framework. Quality assessment of studies, descriptive and thematic analyses were also conducted. We charted, collated, and summarised from four databases. Thirty-one studies met the study criteria consisting of children and adolescents with intellectual disabilities. Median caries prevalence was 70%, decayed missing and fIlled permenant teeth (DMFT) was 2.4, decayed missing and filled decidous teeth (dmft) was 2.36, and DMFS was 3.7. Major determinants were the severity of disability, socioeconomic status and parents' education. Oral care and dental visits were inadequate. Further exploration is required to improve access and reduce caries experience and prevalence among children with intellectual and developmental disabilities in India.

Prevalence and Distribution of Dental Caries among Iraqi People

Abstract Background: Dental caries is the most prevalent oral disease worldwide. It is still a public health problem, particularly in developing countries. Objectives: The aim of this study was to measure the occurrence of dental caries among patients attending dental school and to investigate the type of dental caries by age, sex, and geographic area. Materials and Methods: After obtaining an appropriate ethical approval, the occurrence and type of dental caries according to G.V. Black classification were recorded among all patients aged 16 years and over during routine dental treatment at the dental hospital, College of Dentistry, University of Babylon, Hillah city, Babil governorate. World Health Organization’ criteria were used to diagnose and detect dental caries. Results: The final sample size was 463 individuals distributed as 217 (46.87%) men and 246 (53.13%) women. Overall, 1851 carious lesions were noticed, in which class I (68%) represents the most prevalent type of dental caries in the study sample followed by class II (20%), then class III (6%), and the least prevalent types (3%) were class IV and class V. There was no significant difference regarding the effect of gender on different caries classes (P > 0.05). However, a significant difference was recorded regarding the effect of area of residence on different caries classes (P < 0.05). Conclusions: In this study, high percentage of class I lesions in comparison to other classes of Black’s classification was noticed among the examined patients. Women experienced more dental caries than men and the area of residency had a significant impact on caries experience.

The Relationship Between Socioeconomic Status and Dental Caries Among Adults in India: A Scoping Review

Background: It is well documented that India is an example of the unequal distribution of dental caries among different population groups, as higher prevalence and incidence have been reported among people with a low socioeconomic level. The objective of this review was to systematically map the scientific literature on the effect of socioeconomic status (SES) on dental caries among adults, identify the research gaps in this area, and propose recommendations for future research. Methods: This scoping review was conducted based on the updated framework recommended by Joanna Briggs Institute. Relevant studies undertaken in India were identified by searching Medline/PubMed, EBSCO, and Google Scholar. The search strategy was limited to journal articles published between January 2012 and October 2022. Titles and abstracts were screened, and full texts were reviewed by two reviewers independently. Results: The scoping review comprised 7 cross-sectional studies and 1 cohort study. Most reviewed studies used the Kuppuswamy scale or its modifications to assess the SES. Four studies determined the caries status regarding mean values according to SES and reported higher DMFT (decayed, missing, and filled teeth) among the middle and lower-class SES. Three studies employed regression analysis to determine the association, and all found that the DMFT score was significantly associated with socioeconomic status. Conclusion: The findings of this review confirm the existence of inequalities in caries experience in adults from different socioeconomic backgrounds. More high-quality and follow-up studies are needed to establish the magnitude of the scientific evidence regarding the association between socioeconomic status and dental caries among adults in India.

Multilevel Analysis on Spatial Distribution and Socio-Environmental Factors of Dental Caries in Korean Children

This study aims to identify the regional distribution in the prevalence of dental caries and related multidimensional factors among 12-year-old children in Korea. Data from the 2018 Child Oral Health Survey were used to calculate the average DMFT index of 12-year-old children in metropolitan cities, and a multi-level regression model was applied to explain the regional distribution of dental caries prevalence and related factors. Factors were divided into two levels by administrative structure. This study finds a significant regional difference in the prevalence of dental caries in 12-year-old Korean children across metropolitan cities. Multilevel analysis showed that districtlevel factors (average number of pit and fissure-sealed permanent teeth, dental treatment demand rate, preventive treatment rate, sex ratio, and number of dentists per 100,000 people) and metropolitan-level factors (intakes of cariogenic beverages and number of pediatric dental hospitals and clinics per 100,000 people) had a significant effect on dental caries prevalence (<i>p</i> < 0.05). Individual characteristics and local socio-environmental factors influence the prevalence of dental caries. Especially considering the strong dependence on preventive treatment and accessibility to dental care services, it is necessary to provide adequate preventive treatment and expand health care resources in high-risk areas of dental caries.

Mapping of dental caries incidence based on geographical information system (gis) in elementary school

Background: Dental caries in Central Java, Indonesia is still important problem, around 43.45% even prevalence of caries in early childhood is still high around 82%. As an effort to control and prevent increasing that case, a risk analysis is needed to determine the risk factors supporting caries. Geographical information system (GIS) as a delivery of information on the spread of disease to support planning efforts. Aim of this study is to determine mapping of distribution dental caries incidence based on GIS concerned to analysis of caries risk factors at Elementary School in Semarang. Methods: Using cross sectional analytic survey with spatial vector map data of 31 public elementary schools at Banyumanik district, Central Java and attribute data on distribution of dental caries. Mapping distribution of caries incidence based on secondary data from City Health Office and Community Health Centre using (Quantum GIS QGIS) and Web GIS software. Results: Elementary schools with caries risk factor environment were good (n=16, 52%) and bad (n=15, 48%), otherwise those with health services were good (n=22, 71%) and bad (n=9, 29%). There was a relationship between caries risk factors and dental caries incidence (p value=0.004) and OR 19.83 (environment) and p value=0.027 and OR 7.917 (health services). Conclusion: Mapping distribution of caries incidence based on GIS was in a very high category influenced by bad environmental factors and poor health services.

Caries prevalence and other dental pathological conditions in Vikings from Varnhem, Sweden

In a late Swedish Viking Age population dating from around 10th-12th century AD, the prevalence, distribution and location of dental caries were studied. Tooth wear, other dental pathology and anatomical variations were identified and recorded clinically and radiographically. A total of 3293 teeth were analyzed from 171 individuals with complete and partial dentitions, of which 133 were permanent and 38 deciduous/mixed dentition. The dentitions were studied clinically, using a dental probe under a strong light source, and radiographs were taken for 18 of the individuals to verify and complement the clinical caries registration. Almost half the population, 83 of 171 individuals (49%), had at least one carious lesion. All individuals with deciduous or mixed dentitions were caries-free. The number of teeth affected by caries among adults was 424 (13%) and the surface most susceptible to caries was the root surface. The tooth most commonly affected by caries was the first mandibular molar. Other findings included apical infections, which were detected clinically in 4% of the teeth, and one case of filed front teeth. The findings gave a unique understanding of life and death in this early Christian Viking community and indicated that it was common to suffer from dental caries, tooth loss, infections of dental origin and tooth pain. These Vikings also manipulated their teeth through filing, tooth picking and other occupational behaviors.

The Relationship between Frequency of Consumption of Cariogenic Foods and DMF-T Index in 12-Year-Old Children

The most common oral disease in Indonesia is dental cavities, especially common in school-age children due to their tendency to favor sweet and sticky foods that can cause dental caries. This study aims to identify the relationship between the frequency of cariogenic food consumption and the DMF-T index in 12-year-old children at SDN 05 Batu Taba, Ampek Angkek District, Agam Regency in 2023. This type of research is an analytic study with a cross-sectional design. The study population included 47 respondents aged 12 years from SDN 05 Batu Taba. The research methods involved interviews regarding the frequency of cariogenic food consumption and DMF-T index examination. Data analysis involved univariate and bivariate analysis, with the chi-square test used for bivariate analysis. The results showed that the frequency distribution of cariogenic food consumption was categorized as low 63.8%, medium 19.1%, high 17.0%, and very high 0%. The frequency distribution of dental caries in the good category reached 42.6%, while the bad category reached 57.4%. The statistical test results showed a ρ value of 0.016 <0.005. The conclusion of this study is that there is a significant relationship between the frequency of cariogenic food consumption and the DMF-T index in 12-year-old children at SDN 05 Batu Taba, Ampek Angkek District, Agam Regency. It is recommended to intensify the longitudinal study to better understand the behavioral changes of cariogenic food consumption frequency and its impact on DMF-T index over time.

Prevalence of Caries with its Distribution by Age & Gender in Institutional Clinical Patients

Introduction: Consequence of dental caries is loose of healthy tooth structure which impacts negatively on aesthetics, function, self-esteem and quality of life of the patients. Different age groups and populations exhibit distinct caries prevalence rates, observations of which could provide a useful descriptive measure of caries susceptibility in tooth surfaces. Materials and Methods: In this study, patients attending the Department of Conservative Dentistry & Endodontics of Dhaka Dental College & Hospital, located in Mirpur-14 and Department of Conservative Dentistry & Endodontics of Sapporo Dental College & Hospital, located in Abdullahpur (North Dhaka City), Bangladesh, were examined between 2017 and 2019. The location of dental caries on the teeth surfaces was recorded as following surface: Occlusal , Mesio-occlusal, Disto-occlusal, Proximal and Cervical for statistical evaluation and comparison. Furthermore, the age and gender of the patients were recorded on the chart for each caries tooth. Result: Female had higher incidence 86 (57%) of caries than males 64 (43%). Caries distribution was common in the maxillary jaw (53.38%) than in the mandibular jaw (46.62%). Among our study patient occlusoal surface caries was most commonly observed (43.4%). Then, the proximal surface caries was seen in 28.3% cases. Overall 71.7% prevalence of caries was in occlusal and proximal area. Where, prevalence of proximal and cervical surface caries was higher in maxillary tooth (18.9% and 4.82%) than mandibular tooth (9.3% and 2.6%) respectively. Conclusion: Female are more prevalent to dental caries than male. Occlusoal surface caries is most commonly observed, then, the proximal surface caries are commonly seen. Occlusal surface caries is more common in mandibular tooth than maxillary. Where, proximal and cervical surface caries was higher in maxillary tooth. Medicine Today 2023 Vol.35(2): 78-82

Study of Prevalence and Management of Dental Caries in India: A Systematic Review

Oral cavity is the mirror which reflects general health. Dental caries is widely prevalent globally but the distribution and severity of dental caries varies across countries and regions. Dental caries is a microbial disease of the teeth that results in decalcification of calcified tissue & dissolution of the softened tissue of the teeth. Dental caries has affected the teeth of all nations, irrespective of geographic and bio-cultural differences. Prevalence of dental caries is a pressing health concern affecting at least half of the Indian population.

Geographical distribution of dental caries in children in the southern region of Brazil

The objective was to investigate the experience and severity of dental caries, from the medical records of children who visited the Children's Dental Clinic of a Faculty of southern Brazil, for four years. A cross-sectional study was carried out by analyzing 262 medical records containing information sociodemographic, as well as clinical oral data, to investigate dental caries. Amongst all children included in study, 226 (86.3%) had some teeth with experience of dental caries and 161 (61.5%) had three or more dental caries. The mean dental caries in children aged between 6-8 years was 5.3 ± 3.1, and the average in children aged between 9-12 years was 2.0 ± 1.9. There was association between the severity of dental caries (more than three teeth) and not using dental floss, as well as with the geographical location of residence. Older children were considered to be protected from dental caries. In this study, the experience of dental caries was high, especially in primary teeth, and variables such as the geographical location of residence, absence of flossing were related to the greater severity of dental caries.

Description of Dental Caries in Primary Molars and the Effect of Giving Dental Health Education on Dental and Oral Hygiene in Preschooler

Caries is a tooth surface disease characterized by demineralization caused by acids produced by bacteria during the metabolism of sugar food. Molars are the primary teeth that are most prone to caries. One of the causes of caries is poor dental and oral hygiene. Preschoolers have a lower awareness of and adherence to oral hygiene, increasing the risk of caries. The objective of this study was to examine the caries description of primary molars as well as the effect of dental health education on dental and oral hygiene in preschooler. This study was pre-experimental, with a one-group pretest-posttest design model and a purposive sampling technique. The sample size was 66 children aged 4 to 6 years who attended five preschool facilities in the agro-industrial environment in Arjasa District. SPSS was used to analyze data obtained from objective examinations and questionnaires. The findings included the distribution of primary molars with the most caries-free category in the maxillary first and second primary molars, the distribution of caries in primary molars with the category of enamel caries spread evenly across all maxillary and mandibular primary molars, the distribution of caries in primary molars with the categories Dentin and pulp caries were most common in mandibular first and second primary molars, and the provision of dental health education could improve dental and oral hygiene in preschooler.

Distribution Of Dental Caries Among Primary School Children In Al-Mukalla Area - Yemen

This cross-sectional study is canied out to identify the distribution of dental caries an1ong 400 primary school children of 12 years age in Al-MukalJa area in Yemen.It was found that 198 (49.5%) out of 400 school children have dental caries; of those affected children 51.5% were males, and 48.5% were females. Dental caries was found to occur more in permanent teeth (76.6%) and distributed mostly in the lower jaw (54%). rt is more distributed in mban areas where the affected seen to represent 53%, whereas in the rural areas it was 38%. In comparisori, the distribution of dental caries (am,ong the affected) in private schools (5TYoj is more than that in governmentcrl schools (47%), and the children living i11 areas receive their water supply from Al-Ghail, Source 1, are affected (53.6%) more than those living in areas supplied from Al-Taweela, Source 2, (42.7%). Finally dental caries causes missing of the teeth in 8% of children.

Needs and Barriers to Access Oral Healthcare Services among the Rural Population in Chengalpattu, Tamil Nadu, India: A Cross-sectional Study

Introduction: Disparities in dental service utilisation are substantial and pervasive worldwide. The healthcare services required to address health concerns and the services actually offered are at odds. Rural residents have poor oral health, and they frequently neglect to adopt good oral hygiene habits. Aim: To assess the oral health needs and barriers in accessing oral healthcare services among the rural population in Pulipakkam, Chengalpattu district, Tamil Nadu, India. Materials and Methods: A cross-sectional door-to-door study was conducted in Pulipakkam, Chengalpattu district, in association with Karpaga Vinayaga Institute of Dental Science, Madhuranthagam, Tamil Nadu, India. The study duration was six months, from March 2022 to August 2022. A total of 436 subjects from the rural population were included, and a structured questionnaire consisting of two domains, totalling 27 questions (24 closed-ended and three open-ended questions), was prepared and distributed among the study participants to assess the need (15 questions) and barriers (12 questions) in accessing oral healthcare. The questionnaire was administered in the local (Tamil) language. Additionally, seven demographic data questions were included, and descriptive statistics were performed for the demographic variables. Inferential statistics were used to assess needs and barriers. The World Health Organisation (WHO) oral health assessment questionnaire 2013 was used to assess dental caries and periodontal disease. The Chi-square test was carried out using Statistical Package for the Social Sciences (SPSS) version 20.0 for inferential statistics. The p-value<0.05 was considered statistically significant. Results: The mean age of the study participants was 53.6±2.02 years, and 402 (92%) were married, while 34 (7.8%) were unmarried. Among the total population (N=436), the perceived need was 217 (49.8%), and the barrier was 399 (91.5%). There was no statistically significant difference in the distribution of dental caries among the population with and without perceived need (p=0.909) and with and without barriers to accessing oral healthcare (p=0.542). The majority (N=261, 89.4%) of the population with periodontal diseases (N=292) reported having barriers in accessing oral healthcare services, and there was a statistically significant difference in the distribution of periodontal diseases among the rural population with and without barriers to accessing oral healthcare (p=0.027*). Conclusion: According to the study findings, oral diseases affect individuals who have no needs or barriers, suggesting that they are unaware of their oral health. It is therefore important to increase oral health awareness among rural people.

Incidence of dental barotrauma and temporomandibular joint problems of divers in Turkey

Introduction: In this study, we aimed to examine dental barotrauma and temporomandibular joint (TMJ) complaints in a large group of divers. Method: This survey study included scuba divers older than 18. The questionnaire contained 25 questions about the demographic characteristics of divers, dental health behaviors, and diving-related dental, sinus and/or temporomandibular joint pain Results: The study group consisted of 287 instructors, recreational and commercial divers (mean age 38.96 years) (79.1% males). A total of 46% of divers reported a frequency of tooth brushing less than twice a day; 28% never receive a routine dental examination; 22.6% experienced dental pain after and/or during diving, mostly in the upper posterior teeth (40%); 17% required dental treatment; 77% of these cases are restoration fracture. TMJ symptoms after diving were statistically significantly higher in women (p=0.04). Jaw and masticatory muscle pain in the morning (p<0.001) limitation of mouth opening (p=0.04) and joint sounds in daily life (p<0.001) were recorded as exacerbated after diving; the results were found to be statistically significant. Conclusion: In our study, the localization of barodontalgia was consistent with the distribution of caries and restored tooth areas in the literature. Dive-related TMJ pain was also more common in those with pre-dive problems such as bruxism and joint noise. Our results are important to remind us of the necessity of preventive dentistry practices and early diagnosis of problems in divers. Divers should take personal precautions, such as brushing their teeth twice a day and avoiding the need for urgent treatment. The use of a personalized mouthpiece is also recommended for divers to prevent dive-related temporomandibular joint diseases.

Chapter 2: Epidemiology of Coronal Caries.

This chapter summarizes the clinical data on coronal caries distribution and sociodemographic drivers in children, adults, and older people, at a global level. Mapping global caries prevalence showed an extreme variation on the prevalence, revealing still high rates in several countries. The disease is presented in each group as prevalence by age and mean number of affected teeth. Differences in the prevalence of dental caries in developed and developing countries may be due to not only wide variations in the age groups studied but also ethnic, cultural, geographic, and developmental differences, as well as access to dental services, healthcare availability, oral healthcare behaviors, nutritional habits, and lifestyles. The prevalence of caries in children and adults showed a decreasing trend in Western countries, notwithstanding the distribution of the disease is highly skewed linked to individual and community determinants. In older persons, a high caries prevalence up to 98% has been reported, with a very heterogeneous distribution among and within countries. Although still highly prevalent, a declining trend for tooth loss was observed. The patterns of the association between sociodemographic indicators and caries data indicate the need of a reform of the global oral healthcare system considering all the life course and caries inequalities. Further needs are related to the production of primary data on oral health to provide support to policymakers to create the national oral healthcare policies guided by epidemiology-based models of care.

Dental caries at enamel and dentine level among European adolescents – a systematic review and meta-analysis

BackgroundIn contrast with the last century, caries epidemiology has begun integrating enamel caries into determinations of caries prevalence and experience. The objective of the present systematic review and meta-analysis was to assess the caries status including estimations of enamel caries, of European adolescents.MethodFour databases (Medline Ovid, Embase, CINAHL, and SweMed+) were systematically searched from 1 January 2000 through 20 September 2021 for peer-reviewed publications on caries prevalence and caries experience in 12–19-year-olds; that also included evaluations of enamel lesions. Summary estimates were calculated using random effect model.ResultsOverall, 30 publications were selected for the systematic review covering 25 observational studies. Not all studies could be used in the meta-analyses. Caries prevalence was 77% (n = 22 studies). Highest prevalence was reported in the age groups 16–19 years, and in studies where caries examinations were done before 2010. The overall mean DMFS score was 5.93 (n = 14 studies) and it was significantly lower among Scandinavian adolescents than among other European adolescents (4.43 vs. 8.89). The proportion of enamel caries (n = 7 studies) was 50%, and highest in the lowest age group (12–15 years). Results from the present systematic review reflected the caries distribution to be skewed at individual-, tooth- and surface levels; at tooth and surface level, also changed according to age.ConclusionsAlthough studies in which the caries examinations had been done in 2010 or later documented a reduction in caries prevalence, caries during adolescence still constitutes a burden. Thus, the potential for preventing development of more severe caries lesions, as seen in the substantial volume of enamel caries during early adolescence, should be fully exploited. For this to happen, enamel caries should be a part of epidemiological reporting in national registers.

Tooth-surface distribution of caries in Greek schoolchildren, using ICDAS-II index. A national pathfinder survey.

The objective of this cross-sectional nationwide study was to assess the caries status of Greek children, in regard to the severity and the distribution pattern of the lesions in the primary and permanent dentition at a tooth-surface level, based on ICDAS-II criteria. Study Design: A national survey was conducted in 15 urban and 9 rural sites and about 50 subjects were examined at each location across the country. Caries data, based on ICDAS-II index, were recorded on 4,410 children aged 5, 12, and 15-years by 10 calibrated dentists. The rankings of the most affected tooth-surfaces, the most vulnerable teeth found cavitated, the right-left symmetry of caries stages and its pattern of distribution shown per jaw or dentition were determined by using descriptive statistics (SPSS v.20). Caries lesions were quite frequent in this school aged child population and the most common code of ICDAS-II observed was that of incipient enamel caries, mainly on the occlusal surfaces, indicative of the need for fissure sealant application. For those surfaces with ICDAS-II=3-6, dental care and intensive prevention programmes, both at home and office based, are needed.

Childhood caries experience in two Aotearoa New Zealand birth cohorts: implications for research, policy and practice

ABSTRACT Oral health in Aotearoa New Zealand has improved in the last seven decades, but improvements among young children have stagnated in the last two. Four out of ten 5-year-olds are affected by caries and many pre-schoolers require dental treatment under general anaesthesia. We analysed data from two longitudinal studies, the Dunedin Multidisciplinary Health and Development Study and the Christchurch Health and Development Study. We compared their methods, cohort characteristics and childhood oral health findings and discuss their implications for policy, research, and practice. Age 5 dmft was obtained in the Dunedin Study from clinical examinations, and from School Dental Service records in the Christchurch Study. Findings were consistent with respect to childhood socioeconomic status, exposure to community water fluoridation, and maternal education. Despite overall improvements, caries rates remain relatively unchanged: dmft in these cohorts, measured in the 1970s–1980s, resemble New Zealand’s statistics for 5-year-olds in the 2000s. Notwithstanding the steep caries decline observed over the years, the caries distribution has shifted, whereby the greatest severity of disease is now concentrated among a smaller group of the most deprived children. Early childhood caries appears to be a useful indicator of deprivation that should inform interventions for those in greatest need.