Dental caries: strategies to control this preventable disease.

OBJECTIVE: To provide a brief commentary review of strategies to control dental caries. Dental decay is one of man's most prevalent diseases. In many counties, severity increased in parallel with importation of sugar, reaching its zenith about 1950s and 1960s. Since then, severity has declined in many countries, due to the wide use of fluoride especially in toothpaste, but dental caries remains a disease of medical, social and economic importance. Within the EU in 2011, the cost of dental treatment was estimated to be €79 billion. The pathogenesis is well understood: bacteria in dental plaque (biofilm) metabolise dietary sugars to acids which then dissolve dental enamel and dentine. Possible approaches to control caries development, therefore, involve: removal of plaque, reducing the acidogenic potential of plaque, reduction in sugar consumption, increasing the tooth's resistance to acid attack, and coating the tooth surface to form a barrier between plaque and enamel. At the present time, only three approaches are of practical importance: sugar control, fluoride, and fissure sealing. The evidence that dietary sugars are the main cause of dental caries is extensive, and comes from six types of study. Without sugar, caries would be negligible. Fluoride acts in several ways to aid caries prevention. Ways of delivering fluoride can be classed as: 'automatic', 'home care' and 'professional care': the most important of these are discussed in detail in four articles in this issue of the Acta Medica Academica. CONCLUSION: Dental caries is preventable - individuals, communities and countries need strategies to achieve this.

From the mouths of babes: dental caries in infants and children and the intensification of agriculture in mainland Southeast Asia.

Many bioarchaeological studies have established a link between increased dental caries prevalence and the intensification of agriculture. However, research in Southeast Asia challenges the global application of this theory. Although often overlooked, dental health of infants and children can provide a sensitive source of information concerning health and subsistence change. This article investigates the prevalence and location of caries in the dentition of infants and children (less than 15 years of age) from eight prehistoric mainland Southeast Asian sites collectively spanning the Neolithic to late Iron Age, during which time rice agriculture became an increasingly important subsistence mode. Caries prevalence varied among the sites but there was no correlation with chronological change. The absence of evidence of a decline in dental health over time can be attributed to the relative noncariogenicity of rice and retention of broad-spectrum subsistence strategies. No differences in caries type indicating differences in dental health were found between the sites, apart from the Iron Age site of Muang Sema. There was a higher prevalence of caries in the deciduous dentition than the permanent dentition, likely due to a cariogenic weaning diet and the higher sensitivity of deciduous teeth to decay. The level of caries in the permanent dentition suggests an increased reliance on less cariogenic foods during childhood, including rice. The absence of a temporal decline in dental health of infants and children strengthens the argument that the relationship between caries and agricultural intensification in Southeast Asia was more complex than the general model suggests.