Caries decline and national regulation in European countries.

After the development of evidence-based, caries-preventive measures and their implementation, the caries decline varies considerably among different countries, which shifts the focus to the importance of regulations and national health policies. Thus, this study assessed the 45-year longitudinal caries development in seven Western and Eastern European countries for 5-7- and 12-year-olds and the according national health policies, regulations and general economic data. Denmark and Switzerland showed an early and marked caries decline after implementing national or regional regulations (1970s) on caries prevention (~1 DMFT, 12y, 1990), while Germany exhibited a similar pattern after adopting equivalent regulations in 1989 (1.2 DMFT, 2010) resulting in <0.5 DMFT for all three countries in the latest surveys. Slovenia and Austria implemented less regulations and subsequent measures resulting in a less pronounced and documented caries decline in 12-year-olds. Croatia and Serbia were engaged in territorial conflicts in the 1990ies and their caries decline came later and to a lesser extent (> 2 DMFT, 2020). For the primary dentition (5-7-year-olds) the epidemiological basis varies to a greater extent and only Denmark implemented an early national epidemiological and preventive strategy from the first tooth on resulting in <1 dmft in 6-year-olds after 2005, while the other countries had at least twice as high values. In conclusion, the difference in caries decline reflect general economic development and the national regulations on oral prevention, indicating the importance for stakeholders to implement evidence-based caries prevention and its monitoring in the respective national health care system.