Dental caries experience in older people over time: What can the large cohort studies tell us?

Dental Public Health, School of Dentistry, The University of Otago, PO Box 647, Dunedin, New Zealand.
British dental journal (Impact Factor: 1.08). 02/2004; 196(2):89-92; discussion 87. DOI: 10.1038/sj.bdj.4810900
Source: PubMed


Little was known of the natural history of dental caries among older adults until recently, but reports from a number of large cohort studies have now enabled better understanding of the nature and determinants of dental caries in older people. The aim of this review is to examine and compare findings from established population-based longitudinal studies of older adults in order to determine their preventive implications.
The dental literature was reviewed in order to identify reports on dental caries incidence from large, population-based dental longitudinal studies of older adults (age 50+) with at least 3 years of follow-up.
Reports were identified from four studies (in Iowa, North Carolina, Ontario and South Australia) which met the criteria; four reports dealt with coronal caries, and five with root surface caries. When annualised, coronal and root surface caries increments were combined and compared with those reported for adolescents, the caries experience of older people over time (between 0.8 and 1.2 new surfaces affected per year) exceeded that reported from cohort studies of adolescents (between 0.4 and 1.2 surfaces per year). The only caries risk factor common to all four studies was the wearing of a partial denture (for root surface caries only).
Older people are a caries-active group, experiencing new disease at a rate which is at least as great as that of adolescents.
Dentate older people should be the target of intensive monitoring and preventive efforts at both the clinical practice and public health levels. There is no easily identifiable 'magic bullet' for preventing caries in that age group, but the use of evidence-based preventive interventions (such as fluoride) should suffice.

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    • "Dental caries is perhaps the major oral problem among older people. Reports from prospective cohort studies of populationbased samples of community-dwelling older people [10,14–16] have shown that dental caries is remarkably active among older people, with a mean increment of about 1 surface per year [17] [18]. That rate is no different from the increment observed among adolescents and younger adults [19]. "
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    • "As dental caries are strongly associated with social determinants experienced during the life course [63] [64] [65], it is possible that social determinants can also influence the longevity of restorations by the same pathway. However, this remains to be established, because most investigations on restoration longevity have focused on materials and techniques or cavity preparation features [2–4,66]. "
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    • "Dental caries is a significant problem for adults. Despite a widely held perception that caries is a disease of childhood, it has become clear that the incidence of new lesions in adults is approximately the same as the incidence in adolescents [1]. Dentistry has been slow to recognize and address this problem. "
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