History of the caries epidemic         Caries of root surfaces occurred in a small proportion of adults in ancient societies, just as it does in 'primitive' societies today. The disease can occur after periodontal disease has caused gingival recession, if the diet contains a high level of carbohydrates, such as plant starches. When such caries occurs it usually causes few problems. The lesions tend to increase in size relatively slowly, over many years. The associated progression of periodontal disease usually causes the loosening and then loss of teeth before such caries progresses sufficiently to cause more severe infection. A very different kind of caries developed and became a problem for people in Europe and then in North America in the 1700's.    The manufacture, distribution and marketing of sucrose as a food additive became common through the development of the sugar cane industry in North America, then the sugar beet industry in Europe.   A large proportion of people in the countries where sucrose became widely available developed rapidly-advancing dental caries which began in the tooth enamel. For reasons that we now understand well, these individuals experienced pain, severe localized infection within relatively dense bone and then systemic illness. Suddenly, a disease which could be extremely painful and even deadly became common in children and young adults.    When the epidemic began no-one understood its cause. All that people could do at the time was treat its consequences. Treatment was by surgery, usually by extracting the tooth, and was very difficult for the surgeon (and very painful for the patient). Surgeons were not particularly admired at the time, because their work was crude, painful and often failed. A new type of surgeon, the dental surgeon, was needed. The dental profession began as a group of people who were also not very admired, but were very much needed.

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