studies conducted under the auspices of the British Association for the Study of
Community Dentistry.
The ravages of dental caries were so severe in the past that the extent of disease in a
population was measured by the proportion of the population with no natural teeth or
edentulousness. A marked decrease in the per cent edentulous between 1968 and 1998
was recorded, especially in adults aged 35-54 years. For younger people, it is common
to record the prevalence (the proportion of people affected), the severity (number of
teeth affected per person) of dental caries and the percentage of carious teeth restored
(Care Index). The drastic improvement in these parameters in the UK between 1973
and 2003 is shown in 228HTable 6.3. About half of all children are now clinically 'caries-
free'. What is of concern is opinion that in the youngest age groups the improvement
is not continuing, and indeed there are signs that caries experience is increasing in
some areas. This is compounded by a decline in the Care Index in the UK.
A decline in caries, first noticed during the 1970s, has been recorded in a large
number of industrialized countries. The dental health of older children continued to
improve in the 1980s but caries experience in primary teeth, measured at ages 5 or 6
years, had stayed fairly constant. The Nordic countries used to have very high caries
experience and the drastic improvement in all five Nordic countries can be seen in
229HFig. 6.7, although it occurred somewhat later in Iceland. One of the most dramatic
improvements has been recorded in Switzerland where the mean DMFT (decayed,
missing, filled teeth) in 12 year olds fell from 8.0 in 1964, to 5.1 in 1972, 3.0 in 1980,
and to 1.1 in 1992. In 15 year olds it fell from 13.9 DMFT in 1964 to 2.2 DMFT in
- Caries experience in Australian children has been well recorded indicating a
dramatic improvement in dental health (230HFig. 6.8). Reports from North America
indicate that caries prevalence and severity in the permanent dentition have continued
to decline since 1982 in Canada and the United States, but that caries experience in
the primary dentition may have stabilized since about 1986-7.
While dental surveys of schoolchildren have been quite common, there is much less
information on the dental health of preschool children mainly because access to them
is more difficult (231HTable 6.4). The prevalence and severity of dental caries in British
preschool children was reviewed by Holt (1990), and in preschool children around the
world by Holm (1990). In most European countries, North America, and Australia,
caries experience has declined in parallel with the increasing use of fluoride
toothpastes, although this decline appears to have stopped in the United Kingdom.
Caries experience of preschool children in South-East Asia, Central America, and
parts of Africa is high and there are discernible trends of increasing prevalence in
parallel with the rise in availability of sugar-containing snacks and drinks.
While the state of the permanent dentition in children has improved dramatically in
many countries, caries in primary teeth is still a considerable problem in preschool
and school-aged children. In industrialized countries, caries experience is highest in
the more deprived groups of society and often in ethnic minority groups. In
developing countries, the reverse social trend is observed, with the well-off, urban
children having the most caries experience. Most of these variations in children's
dental health can be explained in terms of the preventive role of fluoride and the
caries-inducing role of sugary snacks. In adults, provision of dental services and
patient preference for treatments can have a major effect on the state of the dentition,