T.M. Marthaler

Changes in Dental Caries 1953–2003

In the first half of the 20th century, indices and methods of conducting surveys of the level of dental diseases were developed. Modern epidemiological studies began in the fifties and many reliable studies have been conducted after 1960. In the following decades, a substantial decline of caries prevalence was documented in the majority of the highly industrialized countries, with reductions of lifetime caries experience exceeding 75%. The decline comes to an end when low or very low levels of prevalence are reached. Children of low socioeconomic status and immigrants from outside Western Europe, however, generally have higher disease levels and may cause increases in caries prevalence. For this and other reasons, caries epidemiology will remain an indispensable part of dental public health.

Changes in the Prevalence of Dental Caries: How Much Can Be Attributed to Changes in Diet?

Changes in the Prevalence of Dental Caries: How Much Can Be Attributed to Changes in Diet? The members of Workshop A focussed on the dietary factors that can affect the prevalence and increments of dental caries and could account for epidemi-ological changes in populations, either increasing or decreasing this disease. In addition this group considered the possible impact of other, nondietary factors on caries prevalence, especially the use of fluorides. The decline of caries prevalence in children and young adults is easily explained by the widespread use of systemic fluorides and/or increased use of topical fluorides, especially in dentifrices. This decline has been observed primarily in industrial countries where the use of fluorides in various forms has been promoted or recommended. Thus the use of fluorides is recommended for caries prevention. The major reduction in caries prevalence has occurred on smooth surfaces so that now pits and fissures account for the bulk of caries in children. In countries where caries prevalence has declined, supplies of sugars have either decreased, remained stable or slightly increased. The modest reductions of supplies of sugars and of sugars consumed in various forms provide little evidence for a decrease in cariogenic challenge. For individuals at ‘high risk’ of caries, even in countries with declining caries prevalence, intake of sugars (fermentable carbohydrates) continues to be a major factor in the caries process. An association between amount and frequency can be assumed since in longitudinal studies the amount and frequency of intake of sugars correlates with caries increments. Epidemiological data in both developing and developed countries that lack extensive use of fluorides and other preventive measures show a rise in caries prevalence due to increasing supply of refined and processed sugars. No other dietary changes have emerged to account for the substantial changes in caries prevalence.

Radiographic and Visual Appearance of Small Smooth Surface Caries Lesions Studied on Extracted Teeth

Radiographs were taken of 580 unfilled approximal surfaces of all types of extracted permanent teeth with small carious lesions. The reproducibility of radiographic scoring was studied. More lesions w

Caries Prediction on the Basis of Past Caries Including Precavity Lesions

The purpose of the present work was the construction of statistical models which allow the prediction of future high caries increments on the basis of the state of primary teeth and first molars taking into account both precavity lesions and DF experience. A child was considered to be experiencing high caries increment when it had at least four new lesions (new DFS) 4 years after the first examination. Two data sets of children aged 7-10 years were analysed: (1) 803 children examined in 1980 and in 1984. The proportion of children with high caries increment was 25.0%. (2) 477 children examined in 1984 and in 1988. In this group, the proportion of children with high caries increment was 16.6%. In the first group with higher prevalence of caries, sensitivity and specificity were found to be on average at 70%. In the second group, sensitivity and specificity were 77% on average. This results shows that caries prediction may be at least as successful when a refined set of clinical data is used instead of a less extensive set of caries data complemented by salivary buffering capacity and microbiological data.

Urinary Fluoride Excretion in Jamaica in Relation to Fluoridated Salt

The purpose of this study was to compare the urinary fluoride levels in subtropical Jamaica just before the beginning of salt fluoridation (250 mg/kg salt) in 1987 and again 20 months later. Four age groups were studied in three locations with low to intermediate fluoride concentrations in the drinking water. The averages of supervised, timed morning fluoride excretions ranged between 12.1 and 27.9 micrograms/h prior to fluoridation as compared with 23.7-67.4 micrograms/h 20 months after the beginning of the sale of fluoridated salt. The fluoride excretions obtained from 24-hour collections ranged from 169 to 485 micrograms/24 h in 1987 and increased to 304-657 micrograms/24 h in 1989. In 1987, the morning fluoride excretions approximated those of French and Swiss children who had a low fluoride intake, but the fluoride levels of 1989 were similar to the data obtained from children who had an intake of 1.2-1.7 mg F/day or consumed fluoridated water.

Confidence Limits of Results of Clinical Caries Tests with Fluoride Administration

Studies with ingested fluoride have shown that part-time exposure to fluoridated drinking water at school (3 or 5 ppm F) may be effective against dental caries. Using this means of fluoridation or tab

Bone Fluoride Concentrations after 16 Years of Drinking Water Fluoridation

The fluoride content of 147 pieces of vertebral cancellous bone, collected at autopsy from long-term residents in Basle, Switzerland, was determined. A statistical analysis of the results sustained the hypothesis of age-dependent fluoride accumulation in bone. No differences were found between sexes. 4 cases with severe chronic pyelonephritis had definitely elevated fluoride values.