Changing patterns of dental caries in young children presenting at the University of North Carolina School of Dentistry between 1960 and 1984.

Caries prevalence was studied in children aged 3-6 presenting for treatment at the University of North Carolina at Chapel Hill School of Dentistry in the years 1960, 1965, 1970, 1975, 1980, and 1984. It was found that the mean number of dft in 5to 6-year-old children had declined over the observation period and this was associated with a concomitant increase in the percentage of children who were caries free. Histograms of the frequency of occurrence of carious lesions showed a clear trend from a predominance of severely affected children in 1960 to a predominance of caries-free and minimally affected children in 1984. These results all were found to be significant statistically at the 5% level. No such changes, however, were observed in the 3-4 year age group. This finding is believed to reflect the greater proportion of high-risk children in the 3-4 year age group. Previous studies have indicated that the generally declining trend in caries prevalence is less favorable fl~r such high-risk children. Dental caries is declining in the general population. StammI presents overwhelming evidence that caries has declined in the United States between 1971 and 1980, especially among children, and this view is supported by many others. 2-4 Similar reductions have been documented in most other countries throughout the developed world. 5-9 For the dental profession, this reduction comes as the welcome outcome of years of advocating fluoridation and various other caries-preventive measures. For dental educators, however, these developments pose a certain dilemma. Although the total elimination of caries has been and remains our ultimate goal, dental schools must continue to prepare students with sufficient restorative skills to meet the requirements of the affected population as long as a significant incidence of caries persists. This dilemma has been discussed by Bohannan1° and long-range planning has been proposed. While the decline in caries prevalence is established clearly for the overall population, relatively few publications have addressed changes in the caries rate for those children who seek care in a dental school environment. Moreover, studies of caries prevalence rarely include very young children of preschool age. These children, however, constitute a significant proportion of the pediatric case load of an average dental school. At the University of North Carolina, for example, children in the 3-6 year age group accounted for 19% of pediatric screening visits in 1984. In view of the dramatic and well-documented decline in caries prevalence among school children, it would be expected that the pediatric population presenting for treatment in dental schools would show similar trends, but this is by no means established. Planning of the pediatric dental curriculum, particularly in the areas of behavior management and sedation training, assumes an adequate supply of young children with dental needs. The present study of caries prevalence in children from 3 to 6 presenting at the University of North Carolina School of Dentistry therefore was undertaken. Methods and Materials The charts of all pediatric patients accepted into the undergraduate treatment program at the University of North Carolina School of Dentistry in the years 1960, 1965, 1970, 1975, 1980, and 1984 were reviewed. Data were collected for children 3 to 6 years old at the time of the first clinical appointment (as distinct from the preliminary screening appointment). For each child, routine demographic information was collected and relevant clinical data were tabulated. The presence of decayed and filled teeth was in216 CHANGING PATTERNS OF DENTAL CARIES: Bentley and Drake