Dental caries in South Pacific populations: a review

Dental caries (tooth decay) was uncommon in Pacific Island communities before European trading and migration expanded into the Region. The etiology of this oral microbial disease is a consequence of changed diets, food preparation and lifestyle. In particular, the easy availability of a high level of frequent dietary supplementation with refined sucrose (sugar) and carbohydrates is the key factor in the etiology of tooth decay. While tooth decay initially developed as a health problem in the more accessible Pacific islands over a century ago, it has spread increasingly as trading, travel and cash economies have developed to include even the more geographically remote communities. In this review selected epidemiological data are presented to show the magnitude, variation and secular changes in the prevalence of tooth decay in different communities. Tooth decay in conjunction with the historically endemic adult gum diseases poses a major public health problem in terms of pain, premature loss of teeth and the need for oral rehabilitation. Implementation and monitoring of caries control programs is a priority need in most communities. It is impractical to consider a return to indigenous diets and lifestyles as a strategy for caries prevention. Instead promotion of proven modern community preventive programmes, notably appropriate use of fluorides, 'fissure sealants' together with control of excessive consumption of diets rich in refined sugar is required if a significant increase in the levels of tooth decay is to be avoided.