Looks into the possible reasons for reduced caries levels in the population of five-year-olds and informs the reader which are likely to have had impact on caries levels and which have not.
It suggests that wider use of higher fluoride children's toothpastes is a key contributory factor.
Readers can apply this knowledge to help prevent decay even further in children.
Objective To explore possible reasons for the reduction in population caries levels among 5-year-old children in England since 2008.
Design An ecological study to explore possible reasons for the apparent reduction in dental caries, which included changes in survey methods, deprivation levels and ethnic mix of the population, impact of community level oral health improvement interventions, reductions in sugar intake, and increases in the availability of fluoride.
Setting Data were drawn from three consecutive epidemiological surveys undertaken in 2007/8 and 2011/12 (NHS Dental Epidemiology programme for England), and 2014/15 (Public Health England Dental Public Health Epidemiology Programme). Evidence about the possible reasons for the observed reduction in caries levels was drawn from a range of national sources.
Main outcomes measures Severity and prevalence of caries at dentinal level as measured by visual means alone among children aged five years.
Results Reasons relating to changes in methods used in the survey, deprivation and ethnicity were rejected, along with community level interventions, as reasons for whole population level change. The factor relating to reduced sugar intake was neither rejected nor sustained. Reasons relating to increased fluoride availability, in particular that for increased concentration in children's toothpastes, was sustained.
Conclusions The reduction in caries levels among 5-year-olds has most likely been brought about by the wider availability of children's toothpaste containing at least 1,000 ppm fluoride, along with other factors
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Sheiham A . Changing trends in dental caries. Int J Epidemiol 1984 13: 142–147.
Anderson R J, Bradnock G, Beal J F, James P M C . Reduction of dental caries prevalence in English schoolchildren. J Dent Res 1982; 61 (Special issue): 1311–1316.
British Association for the Study of Community Dentistry. Changes in Dental Caries Levels. Report of a BASCD Workshop. BASCD Proceedings 1983, 5, No. 2, 17–23.
Davies G M, Robinson M, Neville J, Burnside G . Investigation of bias related to non-return of consent for a dental epidemiological survey of caries among five year olds. Community Dent Health 2014; 31: 21–26.
Rooney E, Davies G, Neville J et al. NHS Dental Epidemiology Programme for England. Oral Health Survey of 5-year-old children 2007/2008. Available from: http://www.nwph.net/dentalhealth/ (accessed December 2016).
Public Health England. National Dental Epidemiology Programme for England: oral health survey of five-year-old children 2012. A report on the prevalence and severity of dental decay (2013). Gateway number: 2013–183. Available from: http://www.nwph.net/dentalhealth/ (accessed December 2016).
Public Health England. National Dental Epidemiology Programme for England: oral health survey of five-year-old children 2015. A report on the prevalence and severity of dental decay (2016). Gateway No: 2016050. Available from: http://www.nwph.net/dentalhealth/ (accessed October 2016).
NHS Dental Epidemiological Oral Health Survey of 5-year-old children in England. 2007/2008. National protocol. 2007. Available on application via DentalPHIntelligence@phe.gov.uk.
NHS Dental Epidemiological Oral Health Survey of 5-year-old children in England. 2011/2012. National protocol. 2011. Available on application via DentalPHIntelligence@phe.gov.uk.
PHE Dental public health epidemiology programme. Oral health survey of five-year-old children 2014–15. National protocol. Version 2–2014. Available on application via DentalPHIntelligence@phe.gov.uk.
Pine C M, Pitts N B, Nugent Z J . British Association for the Study of Community Dentistry (BASCD) guidance on the statistical aspects of training and calibration of examiners for surveys of child dental health. A BASCD coordinated dental epidemiology programme quality standard. Community Dent Health 1997a; 14 (Supplement 1): 18–29.
Pine C M, Pitts N B, Nugent Z J . British Association for the Study of Community Dentistry (BASCD) guidance on sampling for surveys of child dental health. A BASCD coordinated dental epidemiology programme quality standard. Community Dent Health 1997b; 14 (Supplement 1): 10–17.
Pitts N B, Evans D J, Pine C M . British Association for the Study of Community Dentistry (BASCD) diagnostic criteria for caries prevalence surveys – 1996/97. Community Dent Health 1997; 14 (Supplement 1): 6–9.
Monaghan N, Morgan M Z . Do parents of children with caries choose to opt-out of positive consent dental surveys? Br Dent J 2011; 210: E1.
Office for National Statistics. Painting pictures of place series – topic profiles. A profile of Child Poverty, September 2010.
Institute for Fiscal Studies. Child poverty in Britain: recent trends and future prospects. IFS Working Paper W15/07. Robert Joyce, 2014.
Office for National Statistics, CT0626 – Sex by age by ethnic group. Source: 2011 Census 2016.
Office for National Statistics. Nomis – official labour market statistics. ST101 – Sex and age by ethnic group. Available from: https://www.nomisweb.co.uk/ (accessed October 2016).
Public Health England, National Diet and Nutrition Survey. Results from Years 1, 2, 3 and 4 (combined) of the Rolling Programme (2008/2009–2011/2012). 2014. Gateway number: 2014051.
Public Health England, National Diet and Nutrition Survey Results from Years 5 and 6 (combined) of the Rolling Programme (2012/2013–2013/2014). 2016 Gateway number: 206248.
Department of Health with BASCD. Delivering better oral health – an evidence-based toolkit for prevention. London, 2007. Gateway Ref. 8504.
Department of Health with BASCD Delivering better oral health – an evidence-based toolkit for prevention. 2nd edition. London, 2009.
Public Health England. Delivering better oral health: an evidence-based toolkit for prevention. 3rd edition. 2014. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/605266/Delivering_better_oral_health.pdf (accessed August 2017).
Davies G M, Worthington H V, Ellwod R P, Blinkhorn A S, Taylor G O, Davies R M . A randomised controlled trial of the effectiveness of providing free fluoride toothpaste during pre-school years on reducing caries in 5–6 year old children. Community Dent Health 2002; 19: 131–136.
Marinho V C C, Higgins J P T, Logan S, Sheiham A . Fluoride toothpastes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2003; CD002278.
Chestnutt I G, Schafer F, Jacobson A P, Stephen K W . The influence of tooth brushing frequency and post-brushing rinsing on caries experience in a caries clinical trial. Community Dent Oral Epidemiol 1998; 26: 406–411.
Chesters R K, Huntington E, Burchell C K, Stephen K W . Effect of oral care habits on caries levels in adolescents. Caries Res 1992; 26: 299–304.
Silness, J, Loe H . Periodontal disease in pregnancy. II Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 1964; 22: 121–135.
Marinho V C C, Worthington H V, Walsh T, Clarkson J E . Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2013; CD002279.
NHS Business Services Authority. Fluoride varnish applications recorded on FP17s for children. Ad hoc analysis (2016).
NHS Digital. NHS Dental Statistics for England 2014/15. Annex 2. Published 20 August 2015. Available at: https://digital.nhs.uk/catalogue/PUB18129 (accessed 16 August 2017).
NHS Digital. Child Dental Health Survey 2013, England, Wales and Northern Ireland [NS]. 2015. Available at: http://content.digital.nhs.uk/catalogue/PUB17137 (accessed December 2016).
Welsh Oral Health Information Unit. Picture of oral health 2016. Dental Epidemiological Survey of 5 year olds 2014/15. Available at: http://www.cardiff.ac.uk/__data/assets/pdf_file/0006/218589/Picture-of-Oral-Health-2016.pdf (accessed December 2016).
The authors acknowledge the considerable efforts of the fieldwork teams in collecting the data for the national surveys and the commissioners who support them. They also acknowledge the assistance given by NHS Digital, PHE Diet and obesity team, and other external partners, including those from industry, who have assisted with provision of information used in this investigation.
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Davies, G., Neville, J., Jones, K. et al. Why are caries levels reducing in five-year-olds in England?. Br Dent J 223, 515–519 (2017). https://doi.org/10.1038/sj.bdj.2017.836
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