Factors for changes of caries prevalence among adolescents in Germany.

Data on caries prevalence among adolescents in East and West Germany before and after unification (1990) were compared with changes in etiologic and preventive parameters. The postwar increase of total sugar consumption resulted in an increase of caries prevalence among adolescents in both East and West Germany until 1970. Parallel to the introduction of preventive measures, especially systemic fluoridation, the national caries level in East Germany stabilized at 4-5 DMFT (in 13-14-year-olds) with significant regional differences. The introduction of fluoridated toothpaste after 1973 in West Germany was followed by a caries decline in children (1970s) and in adolescents (1980s) from very high caries levels (8.8 DMFT in 13-14-year-olds in 1983) to moderate levels (5.1 DMFT in 1989). The sudden increase from 10% to 90% fluoridated toothpaste in East Germany in 1990 was also accompanied by a caries decline in adolescents. Group prevention, which included fluoride varnish programs and the introduction of free prevention (brushing instructions, fluoridations, sealants) at private dentists for 6-19-year-olds since 1983, seems to be responsible for the latest caries reductions all over Germany.