Why are caries levels reducing in five-year-olds in England?

Key Points

  • 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.

Abstract

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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Acknowledgements

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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Correspondence to G. M. Davies.

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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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