Changing patterns of dental caries: a survey of 20 countries.

Data on oral health, sugar consumption, fluoride availability and other preventive programmes from twenty selected developed and developing countries were reviewed to identify the changes in oral health in children and causes associated with these changes during the past 20 years. Nine developed (industrialized) countries showed apparent substantial reduction (30-50 per cent) in the prevalence of dental caries in 5 and 12 year old children during the past decade. The countries are: Australia, Denmark, Finland, Netherlands, New Zealand, Norway, Sweden, United Kingdom and the USA. Caries in Thailand and Nigeria and other developing countries appear to have increased considerably. The most probable reasons for the decrease in dental caries in children in the developed countries were considered to be associated with: the widespread exposure to fluoridated water, fluoride supplements, especially the regular use of fluoridated toothpaste; the provision of preventive oral health services; the increased dental awareness through organised health education programmes; the ready availability of dental resources. The factor common to all countries with a substantial reduction in caries was fluoride, either as fluoridated water or toothpaste. Countries with decreased caries but no fluoridated water supplies all had experienced a rapid increase in the availability and the use of fluoridated toothpaste during the past 10 years. The contribution of improved dental health programmes, other than those involving fluoride, could not be adequately assessed. These changes, which appear to be continuing, have relevance also to similar countries which might just be entering the reduction phase, or for which that phase may already have begun, though it is as yet unnoticed and unreported. They also have relevance to developing countries in indicating how caries and perhaps periodontal disease have been controlled and prevented. It is inevitable that in developed countries with reducing dental caries there will be a decreased need for dental services and hence a change in the need for dental personnel. However, the lack of adequate data in most countries makes prediction of future changes in oral health and manpower needs a precarious procedure. The whole review indicates the urgent need for regular monitoring of oral health status in all countries and for better personnel planning and production.