From Control to Elimination: Making the End of Dental Caries Thinkable

Dental caries remains one of the most prevalent noncommunicable diseases worldwide despite decades of clinical and behavioural interventions. Persistently high prevalence suggests that current approaches are better organised for ongoing disease management than for preventing new disease occurrence. This commentary examines whether an elimination framework could provide a more coherent and outcome-oriented direction for oral health policy and practice.

We apply the Dahlem Framework to assess whether dental caries meets established criteria for disease eradication. We then position caries within the classical continuum of control, elimination, and eradication, drawing on current evidence on caries aetiology, fluoride exposure, dietary environments, primary care integration, surveillance, and the social and commercial determinants of oral health.

Dental caries does not meet the criteria for eradication. It has no single causal agent, no interruptible transmission cycle, no immunising intervention, and no global surveillance architecture capable of detecting incidence. Eradication is therefore conceptually impossible. Elimination, however, defined as the stable disappearance of dental caries as a public health problem within a defined population, is biologically plausible and operationally achievable. An elimination frame shifts expectations from managing recurrence to preventing occurrence and reframes caries as a system outcome rather than solely an individual behavioural or clinical problem.

Caries elimination is not the promise of biological absence, but a realistic and measurable population health objective. Adopting an elimination framework could strengthen policy coherence, surveillance, implementation research, professional education, and accountability, while reorienting oral health systems toward prevention, equity, and sustained population-level impact.