Caries in populations - a theoretical, causal approach

The focus of this paper is caries in populations. Caries is assessed as a p henom enon and as it occurs in populations. It is observed that in recent l iterature the notion of causation of caries is restricted to the biological process on the tooth surface. This may be sufficient to explain caries as a phenomenon, but it is argued that a biological causation is insufficient in order to understand caries and its variation in populations. The underst anding of the determinants of a population's oral health has been seriously impeded by the absence of a theoretical framework. A framework would be us eful to the extent that it would bridge relevant categories for portraying complex causal patterns of caries in populations. An approach to a framewor k has therefore been outlined, and the idea of such a Framework has been co nfronted with three critical comments. The framework is as yet pragmatic, i ncomplete, uncertain and fragmented. Yet, even such an approach may invite greater precision in epidemiological concepts about causes of caries than p resently prevails. The framework directs attention to health effects of col lective phenomena that cannot bu reduced to individual attributes. The imag e proposed in this paper is intended to spur discussion about important asp ects of the epidemiology of caries in populations.