- Email: [email protected]
Significant of untreated caries
risk factor approach, and preventing and/or controlling major noncommunicable diseases. Behavior science projects and clarification and standardization of scientifically and clinically relevant indicators for oral health are also of interest. Vision 2020.—In Vision 2020, a new model of oral health care is proposed, led by dentists and other stakeholders. This initiative has inspired FDI to address political, social, and economic factors involved in providing dental care, oral health care, and overall health care to the world’s populations. Specific needs to be addressed include the need to develop indicators and data on oral health, the need for oral health delivery through collaborative efforts, and the need to identify the potential impact of sustainable development and ISO 26000 standards on the dental profession and the dental industry. The FDI Data Hub for Global Oral Health is the first project launched under Vision 2020. This online database collates oral health and related data from various international sources. Its purpose is to support advocacy efforts for dentistry and ensure that oral health is included in health policy decisions (Fig). FDI also supports the development of research programs to identify indicators and collect socioeconomic data that will more effectively undergird other advocacy work on the causes of oral disease. Global Dental Needs.—The Minamata Convention on Mercury is designed to limit mercury emissions into the air, water, or land and eventually to become international law. The phase-down of dental amalgam is supported. FDI has issued guidelines to suggest ways this convention can be implemented. In addition, researchers and dental
practitioners will be able to support evidence-based policies through monitoring the actual use of amalgam and other restorative materials and their clinical effectiveness. FDI’s Strategy for Africa provides a capacity-building approach to management designed to professionalize and ensure the long-term viability of NDAs in Africa. In addition, it has the capacity to develop communications by which needs and advocacy for oral health policies and planning can be communicated nationally, regionally, and internationally.
Clinical Significance.—FDI is working closely with the IADR and other partners to respond to new political, social, developmental, and economic issues with respect to dentistry on the international front. Vision 2020 offers inspiration for progressive initiatives in this context. Member NDAs are supported and enhanced through the activities of FDI in promoting knowledge and applying influence at various levels, ensuring that the message about the importance of oral health is conveyed effectively.
Wong TC, Eisel e J-L: FDI World Dental Federation: Responding to new realities of oral health. J Dent Res 94:519-521, 2015 , FDI World Dental Federation, Reprints available from J-L Eisele Av Louis Casai 51, 1216, Gen eve-Cointrin, Switzerland; e-mail: [email protected]
Global Dental Caries Significant of untreated caries Background.—Most reviews on caries epidemiology focus on caries experience, including little information about untreated caries. As a result, the epidemiology of untreated caries remains largely unknown. The Global Burden of Disease (GBD) 2010 study systematically produces comparable estimates of the burden of 291 diseases and their 1160 sequelae between 1990 and 2010. The prevalence and incidence estimates of untreated caries were documented for 187 countries, 20 age groups, and both sexes between 1990 and 2010. Methods.—A systematic literature search identified 192 studies of 1,502,260 children age 1 to 14 years in 74
300
Dental Abstracts
countries and 186 studies of 3,265,546 individuals age 5 years or older in 67 countries that documented untreated caries. These were analyzed in separate metaregressions for deciduous and permanent teeth, respectively, using the GBD 2010 modeling resources. Results.—Of the 192 studies included in studies of untreated caries in deciduous teeth, most were prevalence surveys based on national or subnational reports. All noted an increase in the number of caries with each decade. Nine percent of the world’s population were affected in 2010, which represented a static age-standardized prevalence between 1990 and 2010. Sex differences were not significant in
Fig. 4.—Age-standardized incidence (proportion) of untreated caries in permanent teeth in 2010: Worldwide. Courtesy of Kassebaum NJ, Bernabe E, Dahiya M, et al. Global burden of untreated caries: A systematic review and metaregression. J Dent Res. 2015;94:650–658.
2010, having narrowed over the 20-year period. The peak prevalence was noted at age 6 years, with no appreciable change in this pattern between 1990 and 2010. Differences were noted in age-standardized prevalences for various countries, with the lowest in Australia (4.8%) and the highest in the Philippines (10.8%). Significant differences were also noted in age-standardized incidence, with the highest in the Philippines (19,914 cases per 100,000 person-years) and the lowest in Australia (8835 cases per 100,000 person-years). Studies of untreated caries in permanent teeth most often were conducted in Western Europe, high-income North America, and Eastern sub-Saharan Africa. More incidence surveys than prevalence surveys were included, with most drawn from national or subnational reports. Thirty-five percent of the global population was affected by untreated caries in permanent teeth in 2010, making it the most prevalent condition worldwide. The agestandardized prevalence was constant at 35% between 1990 and 2010. No significant differences were noted between men and women in 2010. Peak incidence was at age 25 years, with a second peak at age 70 years. This pattern was static between 1990 and 2010. Agestandardized prevalences varied by country, with the lowest in Singapore (12%) and the highest in Lithuania (68%) (Fig. 4). Similar differences were found in agestandardized incidence, with the lowest in Nigeria (9945
cases per 100,000 person-years) and the highest in Iceland (76,472 cases per 100,000 person-years). The data also indicated that 15 new cases of tooth decay will occur each year for every 100 people followed up. In addition, 27 new cases of tooth decay will develop in permanent teeth each year for every 100 people followed up. Discussion.—Untreated dental caries is a major public health challenge in most countries around the world and affects billions of adults and millions of children. Because of its prevalence and incidence, oral health policy and planning for health care must include consideration of how to manage this disorder. Left untreated, caries causes severe pain and infection that affects children’s participation in school and adults’ productivity at work. It appears that the burden is shifting somewhat from children to adults, with peak incidences at ages 6, 25, and 70 years. However, the actual incidence and prevalence data show that there has been no appreciable change over the past 20 years.
Clinical significance.—Untreated caries in permanent teeth is the most prevalent health condition worldwide. Additionally, untreated
Volume 60
Issue 6
2015
301
caries in deciduous teeth is the tenth most prevalent condition. These data indicate that oral health must be a significant factor in any decisions about health care delivery and interventions worldwide.
Kassebaum NJ, Bernab e E, Dahiya M, et al. Global burden of untreated caries: A systematic review and metaregression. J Dent Res. 2015;94:650–658. Reprints available from W Marcenes, Inst of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary, Univ of London, Turner St, London E1 2AD, UK; e-mail: [email protected]
Global Oral Health Addressing caries management Background.—Challenges related to controlling the increase of caries with age can be found in the Africa and Middle East Region (AMER) of the International Association for Dental Research, as well as in other areas. A look at the dental health problems of the AMER indicates the seriousness of the situation and suggests strategies to reduce oral health car inequalities and thereby address oral disease management issues. Scope of the Problem.—Health planners worldwide often assume that caries can be controlled by fluoride. However, the data show a significant loss of teeth during middle age, with indications that dental care must be more closely integrated with general health service systems. Sugars are actually the main cause of caries, and no policies are in place to address excess sugar intake. Social determinants of health behaviors and oral diseases are also overlooked in most oral health planning. Conventional dental approaches are proving insufficient to manage caries. However, the dental profession tends to be resistant or slow to adopt changes. As a result of all these factors, oral disease remains widespread and the traditional approach to dental care provision is too costly in terms of financial and human resources to remain viable. Specific to AMER, levels of caries in 12-year-old children in many African countries are between low and moderate. However, the prevalence of caries is increasing and may continue to grow as more sugars are consumed and fluoride exposure is inadequate. Manpower requirements to manage caries are extremely high, as are costs. Overall, caries is not controlled or adequately treated with the current approaches. Analysis of the situation suggests that any system focused primarily on disease treatment will not be effective against chronic diseases such as caries.
302
Dental Abstracts
Suggested Strategies.—Effective prevention is believed to rely on adopting a shared common risk factor approach. Incorporating programs that promote oral health and the prevention of oral diseases into efforts to prevent and treat chronic diseases is proposed as an alternative to current approaches. AMER countries, for example, are experiencing a serious chronic disease burden and are predicted to experience a large increase in death rates from cardiovascular disease, cancer, respiratory disease, and diabetes. These diseases are linked to overweight and obesity, both of which are increasing rapidly in many countries. Caries levels increase in parallel with obesity rates. Poor nutrition and oral disease are also linked. The traditional ‘‘vertical’’ approach to disease is focused on managing a single disease in isolation. The proposed alternative is a ‘‘horizontal’’ approach, in which a number of diseases are addressed at the same time and the focus is on common risk factors. This approach is more likely to persuade policy makers to change environments and behaviors because many of the targeted diseases are high priorities for governments. Examples include cardiovascular disease, diabetes, and obesity. These non-communicable diseases (NCDs) share risk factors with oral disease, making it more effective to use health promotion approaches to prevent all of them at once. The ‘‘Health in All Policies’’ (HiAP) approach is an accepted governmental strategy to improve the health population-wide by coordinating actions across all sectors. The focus is on affecting the risk factors of major diseases and the determinants of these risk factors by measures controlled by government sectors other than the health sector. Societal health determinants are viewed broadly, with an emphasis on health promotion and using governmental policies to increase the likelihood of making healthy
practitioners will be able to support evidence-based policies through monitoring the actual use of amalgam and other restorative materials and their clinical effectiveness. FDI’s Strategy for Africa provides a capacity-building approach to management designed to professionalize and ensure the long-term viability of NDAs in Africa. In addition, it has the capacity to develop communications by which needs and advocacy for oral health policies and planning can be communicated nationally, regionally, and internationally.
Clinical Significance.—FDI is working closely with the IADR and other partners to respond to new political, social, developmental, and economic issues with respect to dentistry on the international front. Vision 2020 offers inspiration for progressive initiatives in this context. Member NDAs are supported and enhanced through the activities of FDI in promoting knowledge and applying influence at various levels, ensuring that the message about the importance of oral health is conveyed effectively.
Wong TC, Eisel e J-L: FDI World Dental Federation: Responding to new realities of oral health. J Dent Res 94:519-521, 2015 , FDI World Dental Federation, Reprints available from J-L Eisele Av Louis Casai 51, 1216, Gen eve-Cointrin, Switzerland; e-mail: [email protected]
Global Dental Caries Significant of untreated caries Background.—Most reviews on caries epidemiology focus on caries experience, including little information about untreated caries. As a result, the epidemiology of untreated caries remains largely unknown. The Global Burden of Disease (GBD) 2010 study systematically produces comparable estimates of the burden of 291 diseases and their 1160 sequelae between 1990 and 2010. The prevalence and incidence estimates of untreated caries were documented for 187 countries, 20 age groups, and both sexes between 1990 and 2010. Methods.—A systematic literature search identified 192 studies of 1,502,260 children age 1 to 14 years in 74
300
Dental Abstracts
countries and 186 studies of 3,265,546 individuals age 5 years or older in 67 countries that documented untreated caries. These were analyzed in separate metaregressions for deciduous and permanent teeth, respectively, using the GBD 2010 modeling resources. Results.—Of the 192 studies included in studies of untreated caries in deciduous teeth, most were prevalence surveys based on national or subnational reports. All noted an increase in the number of caries with each decade. Nine percent of the world’s population were affected in 2010, which represented a static age-standardized prevalence between 1990 and 2010. Sex differences were not significant in
Fig. 4.—Age-standardized incidence (proportion) of untreated caries in permanent teeth in 2010: Worldwide. Courtesy of Kassebaum NJ, Bernabe E, Dahiya M, et al. Global burden of untreated caries: A systematic review and metaregression. J Dent Res. 2015;94:650–658.
2010, having narrowed over the 20-year period. The peak prevalence was noted at age 6 years, with no appreciable change in this pattern between 1990 and 2010. Differences were noted in age-standardized prevalences for various countries, with the lowest in Australia (4.8%) and the highest in the Philippines (10.8%). Significant differences were also noted in age-standardized incidence, with the highest in the Philippines (19,914 cases per 100,000 person-years) and the lowest in Australia (8835 cases per 100,000 person-years). Studies of untreated caries in permanent teeth most often were conducted in Western Europe, high-income North America, and Eastern sub-Saharan Africa. More incidence surveys than prevalence surveys were included, with most drawn from national or subnational reports. Thirty-five percent of the global population was affected by untreated caries in permanent teeth in 2010, making it the most prevalent condition worldwide. The agestandardized prevalence was constant at 35% between 1990 and 2010. No significant differences were noted between men and women in 2010. Peak incidence was at age 25 years, with a second peak at age 70 years. This pattern was static between 1990 and 2010. Agestandardized prevalences varied by country, with the lowest in Singapore (12%) and the highest in Lithuania (68%) (Fig. 4). Similar differences were found in agestandardized incidence, with the lowest in Nigeria (9945
cases per 100,000 person-years) and the highest in Iceland (76,472 cases per 100,000 person-years). The data also indicated that 15 new cases of tooth decay will occur each year for every 100 people followed up. In addition, 27 new cases of tooth decay will develop in permanent teeth each year for every 100 people followed up. Discussion.—Untreated dental caries is a major public health challenge in most countries around the world and affects billions of adults and millions of children. Because of its prevalence and incidence, oral health policy and planning for health care must include consideration of how to manage this disorder. Left untreated, caries causes severe pain and infection that affects children’s participation in school and adults’ productivity at work. It appears that the burden is shifting somewhat from children to adults, with peak incidences at ages 6, 25, and 70 years. However, the actual incidence and prevalence data show that there has been no appreciable change over the past 20 years.
Clinical significance.—Untreated caries in permanent teeth is the most prevalent health condition worldwide. Additionally, untreated
Volume 60
Issue 6
2015
301
caries in deciduous teeth is the tenth most prevalent condition. These data indicate that oral health must be a significant factor in any decisions about health care delivery and interventions worldwide.
Kassebaum NJ, Bernab e E, Dahiya M, et al. Global burden of untreated caries: A systematic review and metaregression. J Dent Res. 2015;94:650–658. Reprints available from W Marcenes, Inst of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary, Univ of London, Turner St, London E1 2AD, UK; e-mail: [email protected]
Global Oral Health Addressing caries management Background.—Challenges related to controlling the increase of caries with age can be found in the Africa and Middle East Region (AMER) of the International Association for Dental Research, as well as in other areas. A look at the dental health problems of the AMER indicates the seriousness of the situation and suggests strategies to reduce oral health car inequalities and thereby address oral disease management issues. Scope of the Problem.—Health planners worldwide often assume that caries can be controlled by fluoride. However, the data show a significant loss of teeth during middle age, with indications that dental care must be more closely integrated with general health service systems. Sugars are actually the main cause of caries, and no policies are in place to address excess sugar intake. Social determinants of health behaviors and oral diseases are also overlooked in most oral health planning. Conventional dental approaches are proving insufficient to manage caries. However, the dental profession tends to be resistant or slow to adopt changes. As a result of all these factors, oral disease remains widespread and the traditional approach to dental care provision is too costly in terms of financial and human resources to remain viable. Specific to AMER, levels of caries in 12-year-old children in many African countries are between low and moderate. However, the prevalence of caries is increasing and may continue to grow as more sugars are consumed and fluoride exposure is inadequate. Manpower requirements to manage caries are extremely high, as are costs. Overall, caries is not controlled or adequately treated with the current approaches. Analysis of the situation suggests that any system focused primarily on disease treatment will not be effective against chronic diseases such as caries.
302
Dental Abstracts
Suggested Strategies.—Effective prevention is believed to rely on adopting a shared common risk factor approach. Incorporating programs that promote oral health and the prevention of oral diseases into efforts to prevent and treat chronic diseases is proposed as an alternative to current approaches. AMER countries, for example, are experiencing a serious chronic disease burden and are predicted to experience a large increase in death rates from cardiovascular disease, cancer, respiratory disease, and diabetes. These diseases are linked to overweight and obesity, both of which are increasing rapidly in many countries. Caries levels increase in parallel with obesity rates. Poor nutrition and oral disease are also linked. The traditional ‘‘vertical’’ approach to disease is focused on managing a single disease in isolation. The proposed alternative is a ‘‘horizontal’’ approach, in which a number of diseases are addressed at the same time and the focus is on common risk factors. This approach is more likely to persuade policy makers to change environments and behaviors because many of the targeted diseases are high priorities for governments. Examples include cardiovascular disease, diabetes, and obesity. These non-communicable diseases (NCDs) share risk factors with oral disease, making it more effective to use health promotion approaches to prevent all of them at once. The ‘‘Health in All Policies’’ (HiAP) approach is an accepted governmental strategy to improve the health population-wide by coordinating actions across all sectors. The focus is on affecting the risk factors of major diseases and the determinants of these risk factors by measures controlled by government sectors other than the health sector. Societal health determinants are viewed broadly, with an emphasis on health promotion and using governmental policies to increase the likelihood of making healthy