Davies G M, Neville J, Jones K, White S
Public Health England, 5th Floor, 3 Piccadilly Place, Manchester, M1 3BN.
Br Dent J. 2017 Nov;223(7):515-519. doi: 10.1038/sj.bdj.2017.836. Epub 2017 Oct 3.
Objective To explore possible reasons for the reduction in population caries levels among 5-year-old children in England since 2008.Design An ecological study to explore possible reasons for the apparent reduction in dental caries, which included changes in survey methods, deprivation levels and ethnic mix of the population, impact of community level oral health improvement interventions, reductions in sugar intake, and increases in the availability of fluoride.Setting Data were drawn from three consecutive epidemiological surveys undertaken in 2007/8 and 2011/12 (NHS Dental Epidemiology programme for England), and 2014/15 (Public Health England Dental Public Health Epidemiology Programme). Evidence about the possible reasons for the observed reduction in caries levels was drawn from a range of national sources.Main outcomes measures Severity and prevalence of caries at dentinal level as measured by visual means alone among children aged five years.Results Reasons relating to changes in methods used in the survey, deprivation and ethnicity were rejected, along with community level interventions, as reasons for whole population level change. The factor relating to reduced sugar intake was neither rejected nor sustained. Reasons relating to increased fluoride availability, in particular that for increased concentration in children's toothpastes, was sustained.Conclusions The reduction in caries levels among 5-year-olds has most likely been brought about by the wider availability of children's toothpaste containing at least 1,000 ppm fluoride, along with other factors.
目的 探究自2008年以来英国5岁儿童群体龋齿水平降低的可能原因。设计 一项生态学研究，以探究龋齿明显减少的可能原因，包括调查方法的变化、人群的贫困水平和种族构成、社区层面口腔健康改善干预措施的影响、糖摄入量的减少以及氟化物可及性的增加。背景 数据来自于2007/8年和2011/12年（英国国民保健制度牙科流行病学项目）以及2014/15年（英国公共卫生署牙科公共卫生流行病学项目）进行的连续三次流行病学调查。关于观察到的龋齿水平降低的可能原因的证据来自一系列国家来源。主要结局指标 通过仅目视检查测量5岁儿童牙本质水平龋齿的严重程度和患病率。结果 与调查方法、贫困和种族变化相关的原因，以及社区层面的干预措施，均被排除作为整个人口水平变化的原因。与糖摄入量减少相关的因素既未被排除也未得到证实。与氟化物可及性增加相关的原因，特别是儿童牙膏中氟浓度增加的原因，得到了证实。结论 5岁儿童龋齿水平的降低很可能是由于含氟量至少为1000 ppm的儿童牙膏更广泛的可及性以及其他因素所致。
