Europe and Tooth Decay: The Situation is Improving Thanks to Fluorides and New Technologies

Still a Relevant Issue

To this day, tooth decay remains a significant problem even in developed European countries. The situation is better in Western Europe, with a median decayed, missing, and filled teeth (DMFT) index for 12-year-old children around 1, although it varies depending on location, education, and social background. Unfortunately, in Central and Eastern Europe, the situation is considerably different, with the median DMFT value for 12-year-olds reaching three to four times higher. While some regions, such as Latvia and Poland, have recently seen improvements, in other Central and Eastern European countries, the situation has rather deteriorated compared to the past.

Pain and Hospitalization

Tooth decay is a major burden both for the patient and the entire healthcare system. Dental problems are associated with significant pain; for instance, in the UK in 2012, it was even the fourth most common cause of children's hospitalizations. Tooth decay is also one of the diseases affecting individuals of all ages. Expenditures on its treatment, for example in the UK, account for 5–10% of public health funds. However, tooth decay can be largely prevented. An example is Denmark, which has achieved the best oral health in Europe thanks to targeted preventive efforts.

The Situation in Europe by Numbers

• 41% of Europeans claim to have all their original teeth.
• In 1973, less than 10% of 12-year-old children were free of visible tooth decay, whereas by 2009, this figure had risen to two-thirds.
• The DMFT in the UK today ranges from 0.47 in some wealthy areas of southern England to 3.96 in poorer northern regions.
• In Western European countries, the median DMFT index for 12-year-old children is ~1.
• In Eastern Europe and some areas of Central Europe, the median DMFT value for 12-year-olds reaches 3–4.

Are Fluorides Sufficient Defense?

Fluoride compounds in toothpastes play a significant role in these improving results. However, it is gradually becoming evident that fluorides alone are not sufficient. They act on host tissues and their repair only after the harmful bacteria take effect, and conversely, they do not act on plaque itself. Research is therefore focusing on developing ancillary substances that would target the pathogenicity of plaque before tooth decay emerges and develops.

Arginine for High-Risk Patients

The most promising of these substances are the amino acid arginine and an insoluble calcium compound. This combination greatly supports remineralization while preventing the demineralization of tooth enamel by reducing plaque acidity. It helps maintain so-called healthy plaque even in the presence of sugars consumed in food. Therefore, the new generation of toothpastes relies not only on fluorides but also on a combination of 1.5% arginine, an insoluble calcium compound, and 1450 ppm fluoride. This method ensures highly effective care even for high-risk patients.

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Source: Why a new technology is needed to fight tooth decay. Oral Health Dialogue 2015; 1: 3–4.