March 2019

A Wicked Problem is a problem that is impossible or difficult to solve partly because of its multi-component nature and its interconnection with other problems (Rittel & Webber, 1973). There are many Wicked Problems in the field of population oral health; tooth decay being one. Tooth decay is a function of biology (destruction of our tooth enamel); a function of our physical environment (availability, advertising and accessibility of sugar sweetened foods and drinks, availability of dental services); a function of our social environment (norms of oral hygiene and sugar consumption vary by socio-economic strata, country, and cultures); a function of us as individuals (dietary habits, visiting the dentist, oral health beliefs, toothbrushing, use of fluoride, dental anxiety, income); and a function of politics (our city, region and national policies on oral health education, tax on sugar sweetened drinks, water fluoridation, dental payment systems). The ‘Wicked Problem of tooth decay’ therefore involves multiple factors, none of which occurs in a vacuum. There therefore seems little point then in studying them in a vacuum or intervening in a vacuum. Yet, we continue to do so. We have become adept at describing gradients in tooth decay according to income, education or occupation (‘socio-economic inequalities’) or documenting changes in tooth decay over time (‘is caries prevalence better now than 10 years ago’?) or calculating odds associated with individual risk factors (‘lower self-efficacy = worse caries experience’).