Introduction to Dental Caries


Dental caries/tooth decay and periodontal diseases are probably the most common dental diseases in the world. The increase in the prevalence of dental caries is associated with higher consumption of refined sugars. The gradual decrease in the prevalence of dental caries started in the late 70s and early 80s in Australia, New Zealand, United States, and Western Europe due to inclusion of fluoride in public drinking water supply that had the ability to prevent the development of proximal surface caries.   

Image of maxillary central incisors showing advance stage of proximal caries
Image of maxillary central incisors showing advance stage of proximal caries involving pulp.

The decline in the prevalence of dental caries was mostly found in the upper and middle socioeconomic class. On the contrary, the lower socioeconomic class and rural residents retained a higher prevalence of tooth decay. This statement can be backed up by the findings of the Third National Health and Nutrition Examination Survey (NHANES III) by the finding that 80% of the caries occurred in 20% of the children who mostly belonged to lower socioeconomic class or minorities. This effect is characterized as a “polarisation” of caries in which a limited segment of the population experiences most of the diseases.  

We are now seeing this polarization on a worldwide level where the prevalence of caries is declining in developed countries, is increasing in less developed countries and is epidemic in countries with emerging economies. We can say that caries is increasingly being localized in segments of population that can barely afford the necessary dental treatment.  

The cost of the caries to society is huge. The published cost represents only the direct expenses of dental care services. If we consider the total indirect costs, for example, loss of time from work and training of dentists, the amount becomes substantial. Dental decay results in tooth loss that may be difficult to replace due to economic reasons, may lead to nutritional deficiency along with pain, sufferings and cosmetic defects in lower socioeconomic class.  

Walter Loesche described caries and periodontal disease, as “perhaps the most expensive infection that most individuals have to contend with during a lifetime”. 

When it comes to prevention, there have never been public supported programs for the eradication of dental caries. Eradication of dental caries depends on the availability of four variable:   

  1. Eradicator weapon means vaccine  
  2. Too strong and efficient public support  
  3. Popular support for the program and for   
  4. An efficient surveillance system to monitor caries activity on a population level.   

So far, we have not achieved caries eradication completely because these four basic requirements have never been met, specifically, the availability of vaccines. Till today, we have only one, most efficient population-based caries control method-public water fluoridation. But it is a truth that it has not been effective in the prevention of pit and fissure caries of the posterior teeth. Though public water fluoridation and fluoride containing dentifrices are not sufficient to prevent caries in individuals with poor dietary and oral hygiene practices and we do not have sufficient knowledge to eradicate the dental caries at population level; certainly we can provide an individual with good dietary and oral hygiene practices an almost caries free life under professional care.  



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