Fluoride Toothpaste

The effect, at a population level, of the introduction and widespread availability of fluoride toothpaste is clear. Figure 3 shows the falls in caries incidence in 5-year-old and 12-year-old children in the UK seen in successive national representative surveys. A similar picture has been seen in Denmark (Figure 4). Fluoride toothpaste was introduced onto the UK market in around 1976 and rapidly became universal. The falls

1973

1983

1993

1997

Figure 3 The change in the average decay experience of children in the UK. DMFT (decayed, missing, and filled permanent teeth) in 12-year-olds (filled bars) and dmft (decayed, missing, and filled primary teeth) in 5-year-olds (open bars). Data from OPCS (1973-1993) and NDNS (1997).

1973

1983

1993

1997

Figure 3 The change in the average decay experience of children in the UK. DMFT (decayed, missing, and filled permanent teeth) in 12-year-olds (filled bars) and dmft (decayed, missing, and filled primary teeth) in 5-year-olds (open bars). Data from OPCS (1973-1993) and NDNS (1997).

1976 1978 1980 1985 1988 1991 1994 1995 2000 2001 Figure 4 The change in caries experience of 12-year-old children in Denmark. DMFT, decayed, missing, or filled permanent teeth. Data obtained from WHO Collaborating Centre.

in caries prevalence seen at the next survey date (1983) exceeded expectations, based on earlier clinical trials, and led many experts to predict that no further fall would occur. In the event, an even greater decline was seen among 12-year-olds at the next decennial survey (1993). The caries prevalence among 5-year-olds appeared to have reached a plateau by 1993, but later data suggests that further falls in both age groups may have occurred. Regrettably, the self-reported use of fluoride toothpaste (almost certainly an overestimate of actual use) is still not universal, even among children in comfortable socioeconomic conditions.

The variation in caries experience with family income is illustrated for the UK in Figure 5. A clear gradient exists, with the poorest dental health seen in the lowest-income families. Trend data indicates that the greatest improvements have occurred among higher-income families and the least among those at the other end of the socioeconomic scale. The reasons for these differences are not entirely clear, but oral hygiene and the use of fluoride toothpaste appear to be important. Evidence of gum disease (an indicator of oral hygiene) is more common among poorer children.

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