title: Dentistry between pathology and cosmetics.
abstract: In ancient and medieval times, the prevalence of caries and periodontal disease varied. There were no treatments for dental hard tissue, but dental cosmetics played an important role. In the late 19th century, caries levels reached a maximum in Europe and North America after refined sugar became a cheap staple food. Toothlessness became frequent even in young adults. Caries prevention, effective on a public health scale, began with the introduction of water fluoridation in the 1940s. By 1985, dental academia had acknowledged that substantial declines could also be obtained in entire populations through topical fluorides, mainly in toothpastes. While decreasing caries prevalence is irrefutable in affluent countries, the specific reasons of the decline are still a matter of debate. In countries where caries has declined substantially, activities of dentists are shifting towards cosmetic dentistry. However, caries continues to be a problem for the lower socioeconomic strata, even in affluent countries, and is a serious problem in developing countries. Thus, water fluoridation is still important, and salt fluoridation should be considered where water fluoridation is not feasible. Both measures are extremely cheap to implement. Controlled fluoridation has a great potential for developing countries and low social strata of affluent countries. Its reduced effectiveness in high socioeconomic strata of affluent countries, due to the widespread usage of fluoride in toothpastes and other oral care products, should not detract from the public health value of fluoridation.
authors.affiliation: Department of Preventive Dentistry, Periodontology and Cariology, Center for Dentistry, University of Zurich, Zurich, Switzerland. tmarthal@zui.unizh.ch
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Marthaler
mesh_terms: D003731:Dental Caries / Q000266:history*; D004955:Esthetics, Dental / Q000266:history*; D005060:Europe; D005260:Female; D005457:Fluoridation / Q000266:history; D049672:History, 19th Century; D049673:History, 20th Century; D049674:History, 21st Century; D049690:History, Ancient; D049691:History, Medieval; D006801:Humans; D008297:Male; D009066:Mouth, Edentulous / Q000266:history; D009656:North America