Are current models for preventive programs sufficient for the needs of tomorrow?

We can be proud of our accomplishment in the prevention of dental caries. Many children in developed countries are now caries-free; however, by age 50, fewer than 5% of the population is caries-free. The drop in the prevalence of caries among specific age groups is undoubtedly due to widespread exposure to fluorides. However, caries protection by fluorides is not absolute; if caries attack continues throughout life, the prevalence of caries will increase. All available evidence strongly suggests that ambient levels of fluoride in the mouth play a critical role in protection against caries. It is clear that novel methods of delivery, such as sustained-release technology, will be developed to enhance the protective effect of fluoride, utilizing amounts of fluoride significantly less than those currently in use. The problems of preventing dental caries in developing countries are much more severe than those facing Western countries. The prevalence of caries appears to be increasing in no small measure due to the introduction of Western diets. Administration of fluoride through conventional routes is either impractical or inordinately expensive. It appears sensible, therefore, to direct preventive measures through dietary constituents associated with caries. Fluoridation of sugars appears to be highly practical and safe way to reduce the prevalence of caries in such communities. Fluoride and iodide are currently added to salt in many parts of the world. If we are to reduce the prevalence of caries effectively in all countries and in all age groups, current methods of prevention will have to be greatly enhanced, and/or effective additional approaches will need to be developed.