The future of preventive programs in countries with different systems for dental care

From 1990 onward the decline of caries has leveled off in economically developed countries and the effectiveness of preventive programs seems to have diminished. The aim of this paper is to consider the future of caries prevention in the light of the studies conducted during the past decade. A shift from population-based prevention to a high-risk strategy has been promoted in countries where caries is strongly polarized. In Finland, however, an intensive preventive program targeted to high-risk individuals had little effect on caries increment, which suggests that the utility of a high-risk strategy is questionable. The relative effects of population-based methods have also decreased during the last decades. Although discontinuation of water fluoridation had no effect on caries in Kuopio, Finland, water fluoridation is still effective in countries with a lower level of basic prevention and a less homogenous social structure. From the standpoint of cost-effectiveness, the use of professionally applied fluoride gels has been questioned in children with a low caries rate, and the same is probably true for fluoride varnishes. In countries with a high caries rate, a low level of basic prevention, and an unorganized dental care system any preventive program seems to be effective. The importance of fluoride toothpastes as a cost-effective and feasible method of fluoride delivery is indisputable and will be so in all countries irrespective of the caries level and dental care systems. Population-based dental health education continues to be important, also in the countries where the caries rate has so far been low.