Abstract
Dental caries has been identified by the New Zealand (NZ) Ministry of Health (MoH) as the country’s most prevalent chronic disease.1 Dental diseases of the oral cavity include, but are not limited to, dental caries, developmental defects of enamel and/or dentine, dental erosion and periodontal disease.2 Dental caries and periodontal disease are largely preventable and are currently considered significant global health burdens.2,3
Dental caries involves the pathological destruction of tooth tissue by acids produced by cariogenic bacteria, and the progression of this disease can lead to pain, difficulty with eating, sleeping, and concentrating.2 Dental caries is multifactorial, with contributing factors including not only the presence and number of cariogenic pathogens or dental anomalies, but also modifiable factors such as diet, poor oral hygiene, and drug and alcohol abuse. Periodontal diseases affect the gingival tissues (gums) and surrounding tooth-supporting structures, and are a major cause of tooth loss. Periodontal pathogens are primarily responsible for the presence of this disease, with a number of modifiable factors shown to contribute to its severity and progression.2,4 Many of the modifiable risk factors for both dental caries and periodontal disease are also implicated in other chronic diseases such as diabetes, heart disease, and obesity, and they are also inextricably linked to socio-economic deprivation.5-7
Children are born without the bacteria that cause tooth decay; these are likely to be acquired from direct transfer via the saliva of their primary caregiver. If a primary caregiver has high amounts of untreated dental caries, then there is a much greater risk of cariogenic bacteria being passed to their child’s oral cavity, therefore placing them at greater risk of developing dental caries from an earlier age.8,9 Horizontal transmission of cariogenic bacteria between kindergarten children has also been demonstrated, and although the transmission rates are low, measures to disrupt this chain of infection from child to child are needed.10
Poor oral health impacts directly on many aspects of life, including nutrition, education, mental and physical well-being, and it has been directly linked to poor general health.2,3,11,12 Untreated dental caries can result in pain, acute and chronic infection. The appearance of untreated dental caries or lost teeth due to caries can be unsightly, resulting in stigmatisation, embarrassment, and low self-esteem. Both dental caries and periodontal disease cause halitosis (bad breath), impacting negatively on social and personal interactions, and potentially hindering employment opportunities.2
In 2016, the FDI World Dental Federation re-defined oral health as…
“… multi-faceted and includes the ability to speak, smile, smell, taste, touch, chew, swallow and convey a range of emotions through facial expressions with confidence and without pain, discomfort and disease of the craniofacial complex. Further attributes include that it is a fundamental component of health and physical and mental wellbeing. It exists along a continuum influenced by the values and attitudes of individuals and communities; [it] reflects the physiologic, social, and psychological attributes that are essential to quality of life; [it] is influenced by the individual’s changing experiences, perceptions, expectations and ability to adapt to circumstances”.7
This new definition was designed to reflect a move away from the traditional bio-medical model of oral health towards embracing a broader bio-psychosocial model that considers both the impact of oral health on quality of life, and wider social determinants of health.7