Bohannan H M, Disney J A, Graves R C, Bader J D, Klein S P, Bell R M
J Dent Educ. 1984 Feb;48(2 Suppl):45-55.
Dental caries is a disease that recently has undergone, and may still be undergoing, dramatic changes in distribution of incidence and prevalence. The most recent epidemiologic data available have been reviewed in this paper to illustrate that caries is becoming a disease primarily of pits and fissures, with less differentiation than previously acknowledged between fluoridated and fluoride-deficient areas. The present distribution of caries suggests that prevention may be accomplished more effectively through targeted sealant programs than through currently popular mass preventive programs. Existing information can be used to identify logical target groups for sealant programs, and age specific tooth eruption and caries attack information can be used to design delivery methods. Although the adoption of targeted sealant programs represents a departure from the traditional mass approach to prevention in dental programs, the present-day caries distribution requires that the initiation of such programs be given serious consideration. At the very least program administrators are encouraged to invoke the planning-implementation-evaluation process. Current programs should be evaluated carefully in view of today's disease patterns and the clinical significance of the results achieved. The content, design, and timing of future community-based programs should reflect individualized community diagnosis and the application of new epidemiologic data as well as a careful evaluation of the results achieved by current preventive procedures.
龋齿是一种发病率和患病率分布最近已经且可能仍在经历巨大变化的疾病。本文回顾了现有最新的流行病学数据，以说明龋齿正主要成为一种窝沟龋疾病，在氟化区和缺氟区之间的差异比之前所认识到的要小。目前龋齿的分布情况表明，通过有针对性的窝沟封闭计划可能比通过目前流行的大规模预防计划更有效地实现预防。现有信息可用于确定窝沟封闭计划的合理目标群体，特定年龄的牙齿萌出和龋齿发病信息可用于设计实施方法。虽然采用有针对性的窝沟封闭计划背离了牙科项目中传统的大规模预防方法，但当今的龋齿分布情况要求认真考虑启动此类计划。至少应鼓励项目管理人员采用规划 - 实施 - 评估流程。鉴于当今的疾病模式以及所取得结果的临床意义，应对当前项目进行仔细评估。未来基于社区的项目的内容、设计和时机应反映个性化的社区诊断、新流行病学数据的应用以及对当前预防措施所取得结果的仔细评估。
