Advances in Dental Research, Vol 9, 82-88, Copyright © 1995 by International & American Associations for Dental Research
Strategies in the design of preventive programs
O. Fejerskov
Department of Dental Pathology, Royal Dental College, Faculty of Health Sciences, Aarhus University, Denmark.
Dental caries is mostly recorded at the cavity level only. A reduced mean
number of cavities in new age cohorts is often thought of as a result of
prevention of the disease, dental caries. However, what is measured is
rather our success in controlling the disease in such a way that prevalence
of its more severe manifestations (cavities) can be reduced in children.
Caries lesions and periodontal breakdown are cumulative with age and
progress steadily in all populations. Thus, caries is the predominant
reason for tooth loss in almost all age groups. The low prevalence and
skewed distribution of dental caries make several fluoride programs less
(if at all) cost-effective. Rather than considering a "whole population
strategy" as opposed to a "high-risk strategy", it is argued that they
should go hand in hand. However, the high-risk strategy may appear to have
an unfavorable ratio of benefits to costs. So far the available literature
shows no evidence that we have tests which, with sufficient predictive
power, can identify groups or individuals of "high risk". It is therefore
concluded that a population strategy should be maintained and further
developed with emphasis on oral hygiene, because it influences norms and
behavior. More knowledge about the pathogenesis of oral disease is needed
before we can develop truly cost-effective strategies for the prevention of
caries and periodontal breakdown.
