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© International Epidemiological Association 1984 Printed in Great Britain
Sheiham A (The Dental School, University College London, Mortimer Market, London WC1E6JD). Changing trends in
dental caries. International Journal of Epidemiology 1984; 13: 142-147.
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
For the first time ever, the frequency of dental caries is DENTAL CARIES IN INDUSTRIALIZED
greater among children in Third World countries than COUNTRIES
in industrialized countries. Figures from the World Dental caries were uncommon in Western industrial-
Health Organization dental data bank showed that the ized countries such as England before 1850.4-5
average number of teeth with caries per 12-year-old Thereafter the caries rate increased rapidly due mainly
child as assessed by the DMF index (D = decayed, to the rise in sugar consumption from 19 lb/person/
M = missing, F = filled) was 4.1 for Third World year in 1850 to 90 lb/person/year in 1900. The increase
countries in 1982 and 3.3 for industrialized countries. in prevalence and severity was interrupted by the two
Twenty years ago the index was less than 1 DMF- World Wars. Most countries with food rationing
teeth for most underdeveloped countries and as high as experienced decreases of approximately 35% in the
10 DMF-teeth for developed countries.1 The change severity of caries during World War II.6'7 After the war
in pattern of dental caries is well illustrated by dental caries increased reaching a peak in the 1960s.8
comparing the disease severity in two contrasting cities Since the early 1970s there has been a compound
—Boston, Massachusetts and Bangkok. In 1960 the annual reduction ranging from 4.3"% in Scottish 5-6-
DMF in 12-year-olds was 12.3 in Massachusetts and year-olds to 16.7% in Finnish 6-year-olds. Among 11-
0.6 in Bangkok. There has been a marked decline in and 12-year-olds the annual reduction rates were 3.8%
caries in Massachusetts in the past 20 years; the most in The Hague and in Shropshire, England; 4.8% in
recent DMF index was 3.5 at 12 years.2 Bangkok Denmark; 5.1% In the USA; 5.0% in Bristol and
children have experienced a deterioration in their 8.7% in Finland.9
dental status since 1960; in 1982, the DMF was 4.4, a The decline in caries has not been as dramatic in
sevenfold increase.3 adults as in children because caries are mainly a disease
The objective of this article is to review the current of childhood and the reductions in children will only
trends in dental caries, the possible reasons for these be reflected in adults in the next ten years. Nevertheless
trends and the implications for the prevention and reductions in caries in young adults have been
treatment of the disease. reported.10 In England, the greatest decline has
occurred in those adults attending dentists only when
in pain."
The decreases in dental caries in Western countries
Department of Community Dental Health and Dental Practice, The
are encouraging but they should be considered against
Dental School, School of Medicine, University College London, a background of high levels of disease in the 1960s.
Mortimer Market, London WC1E 6JD, UK. And, despite the decreases, the prevalence of dental
142
CHANGING TRENDS IN DENTAL CARIES 143
caries is still unacceptably high and in some countries The reduced intake of sucrose in infants does affect
little or no decline has occurred. For example, in the numbers of cariogenic bacteria and the incidence
England and Wales, where there has been a reduction of caries.20'21
of about 50% in the proportions of children aged 6 There are no reliable data on the per capita sucrose
and 7 years and a decrease in the DMF of 1.5 per child consumption among children during the 1970s.
between 1973 and 1983, 8 out of 10 children aged Children under 16 years of age constitute about one-
10-13 and 9 out of 10 children aged 14-15 had fifth of the total population. So a 25% reduction in
experienced caries. The 15-year-olds still had about six sugar consumption in that age group would result in a
teeth attacked by caries—about 20% of their teeth.12 decrease of only 5% of the national average.22 In
Within the UK there are large differences between Britain the sucrose consumption has decreased by
countries in the levels of dental caries and it appears about 20% in the past 15 years; most of the decrease
that the decline in caries has not been marked in has occurred since 1974. In the USA, although total
Scotland and Northern Ireland. Among 15-year-olds sugar consumption has increased since 1965, sucrose
in England the DMF was 5.6 compared with 6.7 consumption has decreased markedly since 1971.2 The
the reduction from the fluoride toothpaste. Additional populations followed by changes in disease prevalence
benefits from water fluoride were also reported in in the rural groups. The influence of social class is
England between 1970 and 1980. Children in Birming- strong.30-31 In Ethiopia, children from more affluent
ham (fluoridated) experienced a reduction of 54% high social class families had four times more caries in
compared to a 32% reduction in non-fluoridated primary teeth than poorer children and twice as many
Dudley.25 permanent teeth with caries.31
Fluoride supplements such as fluoride tablets and Urbanized populations in underdeveloped countries
drops, and professionally applied topical fluoride may are more likely to consume refined sugars than those in
have been responsible for a very small amount of the rural areas. Therefore it is not surprising that caries
decline. In most countries where declines have been rates are higher in urban populations. In the Sudan,
reported, such as England, Ireland, Holland, these 15-19-year-old urban children had seven times more
measures have not been widely used. The additional caries than children, in rural areas where the sugar
effect of professionally applied fluoride and fluoride consumption was below 5 lbs/person/year.32
in toothpaste is not clinically significant.26 Neither is Deteriorating dental health is seen as a necessary