Changing Patterns Of Dental Caries in Australia

The changing patterns of dental caries in Australia over the past 30 years.

• Dental caries is the most prevalent health condition in Australia. Thus it comes to little surprise that it is so highly analysed + studied to determine risk groups, changing patterns, how best to manage the disease at an individual + population level, preventative measures, and determine the most effective spending of current healthcare funding.

Children

• Over the past 30 years the patterns of dental caries has changed significantly, the general pattern that has emerged from the data, shows a downward linear correlation in the incidence of DMFT (decayed, missing, filled, teeth) values.
• What was once common to have a DMFT of approximately 3 (1970s) in 6 year olds is now about half that at value at 1.5 (1990s).
• Similar trends can be observed in 12 year olds, who as a group once had a mean DMFT of 5 (1970s) now have a DMFT of approximately 1 (1990’s).
• Conversely, although there has been a downward trend from the late 1970’s to the early 1990’s, current data in children suggest that the correlation of incidence of DMFT is not just levelling out, but may actually be increasing once again.
• This may be a statistical blip, as many of the current studies are collected mainly by hygienists and are not considered epidemiological studies.
• One of the most important conclusions emerging in the past 30 years to the present is the fact that the general population of children experiencing caries is decreasing or is even zero; however, the data indicates that the mean is still staying roughly constant around 1, which indicates that certain pockets of risk groups are still significantly affect by dental caries.
• This can be observed from studies with significant caries index values. Which show that if you separate the 10% of most extreme caries individuals and re-calculate the mean you get a DMFT of around 8-9 (which for Australian mean levels is extremely high and more comparable to a third world country score). Thus demonstrating that although overall in the past 30 years caries incidence is decrease there are still certain groups in the population that are still significantly affected.

 

Adults

• Generally there is less data available for adult’s caries experience, with only the 1987-1988 + 2004-2006 oral health survey’s
• The general trends observed over the last 30 years show (similar trends to 6 and 12 year olds) a significant decrease in the overall experience of caries.
• Younger adults showing a greater decline in incidence.
• With the older population showing similar or less of a decrease in caries experience
• These smaller decreases in older populations can be accounted for by the fact that the same cohorts of people are still being affected.
• Further, the data over the last 30 years shows that DMFT values are changing in characteristics as there are less missing teeth per individual; which is attributed to the fact that 30 years ago the diagnosis of a tooth in general had less options available for therapeutic prognoses, compared to current restorative techniques and preventative measures.
• Again, a similar trend of a small population of individuals significantly affected by caries is comparable adults, as noted in the in 6-12 year olds.
• In 1982 the number of adults with a DMFT of 0 was approximately 25%, as of 2000, the number of adults with a DMFT of 0 is approximately 65%.
• This again shows that there is in general a small group of adults who have a significantly higher caries experience, affecting mean values.

Factors: Decreasing Trends

• Factors to account for the decreasing trends of caries experience in the general population over the past 30 years.
• Water fluoridation -> With many of the major cities being fluoridated in the 1970’s, within years the data shows a significant decrease in DMFT values. This decreasing trend can with a significant degree of certainty be related to that fact of water fluoridation
• It has been shown in studies that if the threshold concentration of 0.7ppm F- is achieved in water, the enamel matrix beings to actively take up F- ions and is incorporated into the lattice structure of enamel.
• Further, at this concentration, F- ions are even swapped for Ca ions, making the enamel matrix more resistant to decalcification as F- ions are leached out of solution at a lower pH compared to Ca ions.
• Studies show that individuals living in a community with 0, or <0.3 ppm of F have a higher DMFT compared to those who reside in areas of >0.7 ppm.
• Fluoridated toothpastes -> over the past 30 years the marketability of tooth products and tooth pastes + the public’s general knowledge of Fluoride benefits has helped to cause a decreasing trend in the data.
• Changing behaviour of dentists -> Over the last 30 years the dental communities methods of dealing with caries has also shifted, from a previous role of “extension for prevention” GV black to a more conservative role + preventative role (such as the role of fissure sealants in risk groups).
• Many studies have noted the decreasing relationship between the amount of decay and the number of fissure sealants
• Changing attitude of the community -> In general the public’s knowledge of oral health has increased over the past 30 years with more of a message of oral health being promoted along with general overall public awareness.

Factors: Risk Groups

• Despite the widespread of success with the introduction of Fluoride and the decreasing trends of dental caries, there are still particular risk groups of whom are still affected by dental caries.
• Social + economical environment -> many dental preventive measures are relatively cheap; however, for individuals in tough economical situations their priorities many not be influenced towards preventative measure such as tooth pastes.
• Physical environment -> Data shows that in general the caries experience of individual’s increases from Metro to Rural to Remote residing individuals.
• Past access to care -> Again, ADA data shows that a majority of health care professionals typically reside in major metropolitan areas, and as one goes from Metro to rural to remote, the number of practicing health care professionals decreases.
• Individual behaviour -> Even with CCP-ACP and F- many groups of people can still be significantly affected by dental decay if their individual behaviour does not in general allow for more time remineralisation compared to times demineralization condition (such as apathetic individuals or drug users, etc)
• Genetics -> Further, some individuals may be able to have a very high cariogenic diet and not affected by dental decay, whereas some individuals may have a low cariogenic diet and be significantly affected by dental decay.
• If one considers these factors it is clear how certain risk groups such as less educated, socio-economic disadvantages, indigenous, disabled, rural, remote and overseas individuals are more prone to risk of dental disease.
• For example indigenous individual generally live in rural to remote areas -> less access to care -> less preventative measures -> less access to general care -> less options of dental products -> generally rural and remote have decreased SES -> less options for trying to receive appropriate care -> Rural and remote areas generally have less probability of being fluoridated over >0.7 ppm -> greater risk of decay.

• If one takes these factors into consideration it is clear that certain populations such as the individuals living in the Cape York Peninsula, are at much greater risk for dental disease that other states.
• Evidence: General DMFT across Australia 1-2, Cape York Peninsula 6-7.

Changing Patterns

– Over the last 30 years there have also been changes in the DMFT scores.

– Decreasing M component

– Increasing F component

– Decreasing D component

If you wish for more information on dental caries please do not hesitate to contact Skygate Dental today on (07) 3114 1199 or 0406 579 197.