THE SCIENTIFIC BASIS FOR THE MODELLING OF CARIES PREVENTIVE STRATEGIES
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The decline in dental caries in many industrialised countries has prompted a reassessment of preventive strategies for dental caries. Although methods to prevent dental caries are well established, few data exist on defining the most appropriate combination of preventive methods to be used for differing levels of dental caries. Texts that do outline preventive methods do not make recommendations on the dental caries conditions under which they should be used. The most popular approach is the identification of individuals or groups at high risk. This research aimed to formulate a basis for strategic approaches for the prevention of dental caries in children based on the distribution of dental caries in the population at different caries severity levels. The objectives were to analyse the shapes of distributions and patterns of distribution of caries both within child populations and in individuals at differing severity levels and factors, such as presence or absence of water fluoridation, associated with the distributions. Using Rose's concepts on preventive strategies, approaches to the prevention of caries were developed based on the analyses. The study was divided into three phases. First, both the incremental and distributive properties of dental caries were analysed using the longitudinal United States National Preventive Dentistry Demonstration Programme's data set. The results were subsequently tested using data from both the British Association for the Study of Community Dentistry's national programme in the United Kingdom and from a study carried out by the University of Wales and Walsall Health Authority. Secondly, the intra-oral distribution of caries, by tooth type and sites on the teeth, was analysed to provide the scientific basis for the identification of the differing components of a preventive package. The third phase developed the findings from the first two phases to form the basis for strategy component selection at differing levels of caries. Results indicate that standard relationships exist between the distribution of dental caries within populations and in individuals and that the risk of caries increments will affect the strategic approach. Knowing the DMF provides information on the prevalence and frequency distribution of caries, the variance, the teeth affected and the sites on the affected teeth that will be carious. There is a relationship between the mean caries score of a population and the prevalence of caries within a population which is independent of water fluoride levels. Furthermore, the distributive properties indicate that a small decrease in the risk for a whole population has a greater overall impact on total caries increment than a large decrease in high risk individuals. There is a hierarchy of susceptibility to caries within the mouth which is tooth and tooth site specific. The hierarchy is not linear, certain sites are grouped. This size of the grouping varies. At low levels of caries the groupings are smaller than at high levels of disease. A reduction in the attack intensity which benefited the groupings at higher levels of disease would lead to substantial savings in cavitated sites. The findings suggest that the adoption of a policy for prevention should be determined by the caries level within the child population and that the hierarchical development should affect the choice of components for any preventive strategy. At low levels of caries, only a relatively low percentage of people would benefit from a population based fissure sealant strategy, whilst at high disease levels substantial numbers of a given population will develop approximal lesions in those teeth which would be sealed. Fluoride reduces the overall attack intensity and is not site type specific in its action. Current shortfalls in knowledge relating to fluoride regimes prevent their impact from being modelled accurately.
AuthorsBatchelor, Paul Anthony
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