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PREVENTION AND HEALTH: TOOTH DECAY


Dental disease is the commonest disease in the western world. It consists of three interlinked problem areas:

1. Tooth decay.

2. Gum disease; and

3. The problems of those with no natural teeth.

We have looked at the second and third of these elsewhere. This entry deals with tooth decay.

The majority of tooth loss comes about because of tooth decay in early life and gum disease in adult life. Both start with plaque-a sticky substance that collects on teeth all the time. Plaque is laden with bacteria that live off the sugar in foods we eat. The bacteria produce acid and the acid erodes the bone-hard enamel of our teeth. The bacteria in plaque also play havoc with our gums.

In 1984 25 per cent of the population of England and Wales over the age of 16 had no natural teeth. This is a great improvement on 1968 when the figure was 37 per cent, but the figure is still shocking.

But is the picture for children any better? Unfortunately not. In 1983 in England and Wales 48 per cent of children aged 5 had some experience of decay; and at the age of 14, the average number of decayed, missing or filled teeth was 4.6. Things have improved a little since then and there is increasing evidence that the level of dental decay in children is falling, for some unknown reason, even in areas that do not have fluoridated water. In areas where the drinking water is fluoridated the level of tooth decay in children is much lower than elsewhere.

Only about half of all people with natural teeth go to a dentist in any one year, and a quarter of schoolchildren and three-quarters of pre-school children fail to get regular dental care.

More and better treatment of dental problems is not the answer to this situation-prevention is. Dental diseases are almost all preventable; indeed no area of preventive medicine has been so extensively studied and pursued as has the prevention of dental decay, and the wisdom of trying to treat, rather than prevent, dental disease in whole populations has been seriously questioned. The World Health Organization has stated that, ‘Dental caries cannot be controlled by treatment alone and the problem can be reduced to manageable proportions only by preventive measures aimed at decreasing the prevalence of the disease.’

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