The limitations of a 'high-risk' approach for the prevention of dental caries.
The decline in the prevalence of caries has lead several authors to advocate the adoption of a 'high-risk' approach for caries preventive strategies. This paper analyses such an approach. It argues that the distribution of caries within a population follows certain laws: first, the mean caries score is a function of the prevalence; second, the variance is a function of the mean; and third, for a particular mean score, the distribution within the population is predetermined. Using data from the National Preventive Dentistry Demonstration Programme (NPDDP) in the US and the British Association for the Study of Community Dentistry (BASCD) epidemiological programmes in the UK the functions determining the distribution of caries within the population are examined. The findings indicate the changes in caries experience observed occurred throughout populations and are not confined to subgroups. Strategies limited to individuals 'at risk' would fail to deal with the majority of new lesions. The main emphasis should be centred on a population approach.
Batchelor
Paul
P
Dental Public Health, Department of Epidemiology and Public Health, Royal Free and University College London School, University College London, London, UK. paulb@public-health.ucl.ac.uk
Sheiham
Aubrey
A
D000293:Adolescent; D000704:Analysis of Variance; D002648:Child; D004245:DMF Index; D003731:Dental Caries / Q000453:epidemiology* / Q000517:prevention & control*; D004812:Epidemiologic Methods; D006801:Humans; D011153:Population; D015995:Prevalence; D011313:Preventive Dentistry / Q000379:methods*; D012306:Risk; D016008:Statistical Distributions; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology