Page 19
For the permanent dentition, the severity of dental caries is measured by the Decayed, Missing and Filled Teeth index (DMFT). According to the WHO Global Oral Health Data Bank (5), the global dental caries index among children aged 12 years is 1.6 teeth on average, however, there are marked differences in severity amongst regions. The disease level in children of this age is relatively high in the Americas and in the European region; the index is somewhat lower among children of the Eastern Mediterranean and Western Pacific regions, while at the moment dental caries is less severe in South East Asia and in the African region. The WHO Global Oral Health Data Bank also provides information on the time trends in dental caries experience of children. In most low and middle income countries, dental caries levels were low until recent years while dental caries prevalence rates and dental caries experience have tended to increase rapidly with changing lifestyles and growing consumption of sugars, inadequate exposures to fluoride, and lack of national programmes for prevention of oral disease (1,3). In contrast, a caries decline has been observed in most high income countries over the past 20 years or so. This pattern is seen as the result of a number of public health measures, including effective use of fluoride, coupled with changing living conditions, lifestyles and improved self-care practices, and establishment of school oral health programmes (1,3). Worldwide, dental caries prevalence is high among adults as the disease affects nearly 100% of the population in the majority of countries (1,3). Most high income countries and some countries of Latin America show high DMFT values (i.e. 14 teeth affected by caries or more at the age of 35-44 years) while dental caries experience levels at present are lower in the low income countries of Africa and Asia. Meanwhile, reports are now available on a growing burden of dental caries among adults living in low and middle income countries. In several high income countries older people often have had their teeth extracted early in life because of pain or discomfort, leading to reduced quality of life. The proportion of edentulous adults aged 65 years or more is still high in some countries; meanwhile, in several industrialized countries there has been a positive trend of reduction in tooth loss among older adults in recent years. In parallel, an increase in the proportion of adult people with functional dentition (i.e. 20 teeth or more) reflects the growing use of preventive oral health services available (1,3). 2 Oral Health Programme In low income countries, oral health services are mostly offered from regional or central hospitals of urban centres and little, if any, importance is given to preventive or restorative dental care. Many countries of Africa, Asia and Latin America have a shortage of oral health personnel and generally the capacity of the systems is limited to pain relief or emergency care. In Africa, the dentist to population ratio is approx. 1:150,000 against about 1:2000 in most industrialized countries. Among children and adults suffering from severe tooth decay, teeth are often left untreated or are extracted to relieve pain or discomfort. In the future, tooth loss and impaired oral function are therefore expected to increase as a public health problem in many low and middle income countries. 1.2 Oral health promotion and disease prevention Dental caries is avoidable, thus the need for dental restorative care can be reduced effectively when disease prevention programmes are established at country and community levels. Firstly, countries and communities should advocate a diet low in sugars in accordance with WHO/FAO recommendations (6,7). Among other recommendations, free (added) sugars should remain below 10% of energy intake and the consumption of foods/drinks containing free sugars should be limited to a maximum of four times per day. Secondly, fluoride is most effective in dental caries prevention when a low level of fluoride is constantly maintained in the oral cavity (8) There is clear evidence that long-term exposure to an optimal level of fluoride results in diminishing levels of caries in both child and adult populations (9-12) Fluorides can be obtained from