The prevalence of dental caries in children in the UK has reduced dramatically over the past 5 decades^{[footnote 7]}. This is generally attributed to the introduction of fluoride-containing toothpaste in the early 1970s^{[footnote 4]}. Other factors such as changed social attitudes, access to dental care, developments in preventive dental materials, together with health promoting and clinical practices have also contributed to these changes over time. Yet dental caries, which is largely preventable, remains prevalent and inequalities are marked^{[footnote 8]}.

Surveys of oral health in adults within the UK^{[footnote 9]} suggest that there are 3 cohorts in the population:

• the oldest cohort, who have lost all their teeth, and wear complete dentures
• a middle cohort, who retain most of their teeth, but do so largely because of the efforts of the dental profession who have restored and maintained teeth in those who grew up before fluoride toothpaste became widely available
• the youngest cohort, many of whom are caries-free in their early years

In the immediate future, the number of edentulous (toothless) people will continue to fall. Therefore, more adults will enter older age with some or all of their natural teeth, many of which will be heavily restored. Dental caries is not just a disease of children and young people - new carious lesions can develop at any age. Dental professionals therefore need to be vigilant and take appropriate action to support all patients, irrespective of age, based on their dental caries risk.

Root caries is increasingly a cause for concern and lifelong coronal caries experience is a risk factor for root surface caries experience^{[footnote 10]}. Root caries increases with age and among independently living older adults. Factors such as poor plaque control, xerostomia (dry mouth), coronal decay and having exposed root surfaces are indicators of risk^{[footnote 11]}.

Like many common chronic lifestyle-associated diseases, the prevalence of dental caries is linked with social and economic circumstances^{[footnote 12][footnote 13]} and ethnicity, with the prevalence of dental caries higher in some ethnic groups. It is, however, recognised that there is a complex interplay between these determinants. While some of the variation in disease levels can be accounted for by deprivation (around 41% among 5 year olds)^{[footnote 12]}, it is not the only risk factor, and dental team members play an important role in identifying modifiable risks, and helping individuals to recognise and minimise these risks and enhance protective factors.

Given that dental caries can be identified and is reversible at an early stage, lesions should be identified at an early stage and managed. There is no evidence that a specific dental recall interval influences dental caries development or progression.

The time between dental check-ups should be based on risk, as assessed by the clinician, working with patients (and where appropriate parents or guardians) and will be influenced by preventive care needed. The recall period will change across the life course^{[footnote 32][footnote 33]}, as shown in chapter 1. For example, in children it is good practice for the recall period to be set so that they can obtain optimal prevention through treatments such as the application of fluoride varnish.

For older adults in care homes, having an oral health assessment on entry to the care home is recommended in NG48 by NICE^{[footnote 29]}, supported by access to professional care on a regular basis. Given that these people will be at higher risk of most oral diseases and conditions, shortened recall periods are likely to be the norm.

Dental caries is one of the most prevalent non-communicable diseases nationally^{[footnote 1][footnote 2]} and globally^{[footnote 3]}. The disease is caused by dietary sugars that are broken down by micro-organisms in the biofilm on a tooth surface, which produces acids that, over time, demineralise tooth enamel^{[footnote 4][footnote 5]}.

The process of de- and re-mineralisation is dynamic^{[footnote 4]}. In the early stages of the disease, dental caries can be reversed. However, when factors promoting demineralisation exceed those favouring remineralisation, dental caries progresses (unless checked) into dentine to a point where the tooth surface breaks down and ultimately a cavity forms^{[footnote 5]}.

Effective patient care involves first diagnosing the presence and recording the extent of disease, using contemporary dental caries management tools such as the International Caries Classification and Management System (ICCMS)^{[footnote 6]}. The next step involves:

encouraging a reduction of factors that cause demineralisation, notably sugar consumption enhancement of those factors favouring remineralisation, particularly the availability of fluoride and mineral ions

Effective patient care may be achieved by a combination of preventive actions taken by patients, patient carers and healthcare professionals, supported by higher-level actions that promote policies and active change to facilitate a less cariogenic social environment.