Changing Patterns of Caries KNOW WHY – behind the trends

 Dental caries is the most common & prevalent health problem in Australia, periodontal disease is the 5 th most
common & prevalent. 90% tooth loss due to these 2 diseases
 Caries is very prevalent & very costly!!!!!
 Despite the high prevalence, there has been significant improvement in caries experience over the past 20+
years. A lot of data is regarding children, obtained from Sch Dental Services (SDS)
 BEWARE of MEAN DMFT scores
- focus more on # of people that are ACTUALLY affected by disease
- mean DMFTs masks the severity of disease (esp for people on the high caries end of the spectrum)

 Trends within Australia

o Australia has one of the lowest DMFT scores compared to other countries
o Starting from the late 70s, there was a dramatic and steady decrease in mean DMFT of 6 and 12 year olds. The
decrease began to flatten out at the beginning of the 90s
o 12yos – 90% had caries @1977, 40% had @ late 90s
o Big improvement of ORAL HEALTH over last 20-30yrs in Australia
o As of the late 90s early 00s, there has been a slight reversal of the trend with DMFT and decayed teeth statistics
increasing (mean DMFT going up)
- investigate the cause for the reversal of trend
o However there has also been an increase in the number of unaffected children (DMFT=0 scores also going up)
o DMFT scores + DMFT=0 scores both going up = improvements @ one end of spectrum, worsening @ one end of
spectrum  USE SiC (Significant Caries Index to gain a better picture of caries experience)
 SiC: mean DMFT score for the 30% of population w worst caries experience
 SiC10: mean DMFT score for the 10% of population w worst caries experience
 In 2001, 12yo = SiC 3, SiC10 5, mean 1 6yo = SiC 5, SiC10 9, mean 2
 Can be seen that in the top 10-30% - very severe disease
o The distribution of caries is such that the worst 25% of the population have 75% of the decay, and the best 52%
have only 4%. Hence it is the dramatic increase in caries within this high-risk group that brings up the average.
o Level of dental caries in many countries has been declining in children from late 60s to now
o Changes in distribution of D, M, F components of the index
- ‘decay’ gets converted into ‘filled’, ‘filled’ gets converted into ‘missing’ as people age
- comparing over time: now more filled than missing teeth

 ADULT CARIES EXPERIENCE

o Less data available
o National Oral Health Survey: 2004-06 vs 1987-88 (17 yr time frame)
- large changes in caries exp in younger adults (mean DMFT decreased)
- not much change in DMFT scores in older adults (>55yo)
- older adults: large diff in MISSING & FILLED cmpt
* more MISSING teeth in 87-88, now more FILLED teeth, but still as many teeth AFFECTED by caries
* much less DECAYED teeth now than in 87-88
* main problems: root caries & 2ndary caries

o Mean DMFT score for <21yo @88, then looking at them again @06 – mean DMFT score increased
- adults of all ages are still developing caries over their lifetime
- caries is a problem that occurs throughout life
- the more dmft=0 score for as LONG as possible = less problems in older age
- once in caries/resto cycle – will be in it for life, try to keep ppl out of the cycle for as long as possible (good for
individual health + good impact on health system – won’t reQ significant interventions till much later, hopefully)

o Used to see a lot of filled 6s & 7s  then just 6s  now still 6s, but less common as well

o Australian population is AGING – by 2051 26% of pop will be >65yo! Potential significant increase in people living
in nursing homes (high risk – these people can’t look after themselves)
- caries experience in older adults
- more people keeping their teeth into old age = more complex dental work required
edentulism teeth & restos perio root caries
 - 1970s - 15% of people in nursing home were dentate, these days close to 50% of them are dentate

The overall trend is affected by

 Water fluoridation – Covers 70% of the population (mostly large urban centres)
The decline in caries is less in non-fluoridated areas - still receive some benefit due to the halo effect –
products produced with fluoridated water being shipped to non-fluoridated areas.
 Water fluoridation has a greater effect on DMFT on people of low SES.
 Fluoridated toothpaste
 Changing behaviour by dentists – Increasing importance of prevention e.g. F/S
- improvement of understanding of disease  mgmt strategy changed
 Changing attitudes/behaviours by the community
- pts more interested in understanding/preventing caries
 Sugar consumption has been increasing since the 1960s

 The pattern of declining caries is not uniform and varies between countries, cities and communities
o Exposure to fluoride: water fluoridation, fluoridated toothpastes, other topical fluorides
o SES, past/present access to services
o Gender – Females lose teeth earlier and have fewer sound teeth
o Age – Decreasing incidence after 25 years. Changing type of caries (root caries)
o Intra-oral factors – In order of risk: teeth - molars, premolars, incisors, canines;
surfaces - fissures, proximal, gingival

 Non-F areas have less of a decline in dental caries than F-areas

- despite declines in caries, risk groups have emerged (levels of caries higher than the average)

 Water Fluoridation
o Warmer parts of Aus – 0.7ppmF Victoria – 1ppmF
o Most of our non F communities @ rural, F communities = large urban communities
o 2 gradients: access to water F, access to services
- even areas w water F have a gradient where some ppl have more caries etc

 SES – access to services

o Low SES vs High SES in non-F areas / water-F areas
o High SES grps with non-F areas have less caries than Low SES grps with non-F
o Children from lower SES = more caries than those in high SES
o Fissure sealants – changes r/s bw permanent decay & SES
o Geographic disparity

 High risk groups – higher mean DMFT scores than the mean DMFT of the whole population
o Middle-aged/older adults – hyposalivation, exposure of root surfaces.
More people are keeping their teeth when they age compared to previously
o Exposure to Fluoride
o Low SES – Less access to services
o Less education/less skilled occupations
o Indigenous – Also more edentulous people. Lower rate in remote areas.
o Overseas born, esp. non-english speaking background
o Rural and remote areas* - Lack of fluoridation, lower average SES, less access to services
o Disabilities – Mental, intellectual, physical
o Nursing home residents - # is increasing as Australia’s population is aging
o Those who need assistance in daily living
o Low individual behavior/motivation
o Genetics

 Composition of DMF
o Over time, with increased access to services, there has been a decrease in untreated decay and increase in filled
teeth.
o Missing component has decreased significantly. People are keeping their teeth for longer.
 Distribution of Dentists
o Mostly in capital cities
o Less dentists @ low SES areas & rural areas

 Indigenous People (SIGNIFICANTLY DISADVANTAGED!)

o Metropolitan Indigenous vs Metropolitan Non-Indigenous  more caries in indigenous
o Rural indigenous – very rare to find one without caries
o Much higher mean DMFT in indigenous, Much higher DMFT for rural indigenous vs metro indigenous
o Mean DMFT getting worse & at a faster rate than non-indigenous
o Huge gap in caries experience bw indigenous & non-indigenous
o More untreated decay & more edentulousness in indigenous people