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Attempts to attribute the recent changes in caries prevalence to improvements in dietary habits have been unconvincing. Apart from the difficulty in determining what people are eating and drinking with any accuracy, data on when food and drink have been consumed are needed to assess the overriding dietary influence of frequency of exposure of the teeth to fermentable carbohydrate. These data are rarely collected in surveys and are then of uncertain reliability. All dietary surveys are seriously hampered by the unreliability of the subjective reporting of dietary habits by those surveyed.

The use of nationally aggregated data (such as food-supply data) is hardly more useful, since a large proportion (up to 50%) of the food available for consumption is never actually eaten. Nonetheless, some experts have pointed to changes in caries prevalence following dramatic changes in food supply as evidence of the practical utility of dietary

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I II III III manual IV V

nonmanual

Social class

Figure 5 Percentage of children aged 1.5-4.5years with caries across social-class groups in the UK, calculated from data presented in Hinds and Gregory (1995). Social class I has the highest income, social class V has the lowest.

I II III III manual IV V

nonmanual

Social class

Figure 5 Percentage of children aged 1.5-4.5years with caries across social-class groups in the UK, calculated from data presented in Hinds and Gregory (1995). Social class I has the highest income, social class V has the lowest.

manipulation as a means of reducing the remaining burden of this disease. The weakness of this argument is that predictable changes in caries prevalence at a population level have rarely been seen except under conditions of extreme dietary change, such as during war time. These changes all occurred before the advent of the widespread use of fluoride. When the food supply of fermentable carbohydrates is severely restricted, changes in the frequency of consumption may occur to a degree that is sufficient to alter caries risk when fluoride is not used. Where fluoride toothpaste and oral hygiene are adequate, even such extreme changes in diet are unlikely to alter caries experience materially. In addition, attempts to use dietary manipulation to reduce the risk of caries in free-living populations have proved unsuccessful.

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