Caries decline and national regulation in European countries

Since the development of evidence-based, caries-preventive measures and their implementation, the caries decline has varied considerably among different countries, shifting the focus to the importance of regulations and national health policies. The objective of the present study was to compare caries trends in the primary and permanent dentition in children for seven European countries with different historical backgrounds and to analyze this in terms of the legal regulations and taxonomy of governance, financial and delivery arrangements, as well as implementation strategies of caries preventive measures within their health care systems.

This study assessed the 45-year longitudinal caries development in seven Western and Eastern European countries for 5-7- and 12-year-olds and the relevant national health policies, regulations, and general economic data.

Denmark and Switzerland showed an early and marked caries decline after implementing national or regional regulations (1970s) on caries prevention (~1 DMFT for 12-year-olds, 1990), and Germany exhibited a similar pattern after adopting equivalent regulations in 1989 (1.2 DMFT, 2010), resulting in 0.5 DMFT for all three countries in the latest surveys. Slovenia and Austria implemented fewer regulations and subsequent measures, resulting in a less pronounced and documented caries decline in 12-year-olds. Croatia and Serbia were engaged in territorial conflicts in the 1990s and their caries decline came later and to a lesser extent (> 2 DMFT, 2020). For the primary dentition (5-7-year-olds) the epidemiologic basis varies to a greater extent, and only Denmark implemented an early national epidemiologic and preventive strategy from the first tooth on, resulting in 1 dmft in 6-year-olds after 2005; the values of other countries were at least twice as high.

The difference in caries decline reflects general economic development and the national regulations on oral prevention, indicating the importance for stakeholders to implement evidence-based caries prevention and its monitoring in the respective national health care system.