Caries prevention programs for groups: out of fashion or up to date?

After a caries decline of about 80% in children in Western Europe and other industrialized countries, there should be critical debate about the best way for future caries prevention. Multiple fluoride use played an important role in caries reductions achieved in the 1980s and 1990s, but it also resulted in a polarization of lesion distribution in young people: the majority consists of low-caries or even lesion-free individuals, while a minority is a so-called high caries risk group which seems not to be open to preventive programs. Recent studies indicate that frequent fluoride applications (>6 times/year) in conjunction with effective plaque removal can be a successful approach for effective future caries prevention in high caries risk groups. Health promotion programs that are merely educational and do not provide fluoride do not seem to be effective. Alternatively, preventive measures could be performed at home or in a private practice, but only minimal compliance is reached in high risk groups compared with out-reaching group programs. Thus, group programs are instrumental in providing effective and efficient caries-preventive measures in children. The more expensive time of a dental practice team should be limited to procedures where costly equipment is needed (professional tooth cleaning, sealants, etc.). For efficient caries prevention, measures formerly targeted specifically at either populations, groups, or individuals should be remodeled and aimed to interact in order to achieve optimal oral health in children at a reasonable cost.