Diversity and Complexity: Dental Anomalies and Health Inequalities

Methods: 1, Examine the published data on the development of the dentition for evidence of the general characteristics of Complex Adaptive Systems. 2, Identify factors from this process that could be modified to reduce the frequency of dental anomalies. 3, Apply these findings to strategies designed to reduce oral and general health inequalities.

Results: In the development of the dentition lower level molecular interactions, genetic/epigenetic/environmental, lead to the emergence of higher level cells, tissues and calcified teeth as a self organising process. Antagonistic actions of Fgfs and Bmps influence the expression of Pax 9, while the differentiation of cells is partly regulated by the epigenetic factor histone demethylase. Multitasking, another characteristic of Complex Adaptive Systems, occurs as genetic pathways act simultaneously and in parallel. The self adaptive characteristics of critical phases, robustness and diversity have also been identified. From the multifactorial interactions leading to dental anomalies, it is the general environmental factors of poor nutrition, infection, toxins and trauma that could most readily be targeted.

Conclusions: 1, Diversity and Complexity affect the development of the dentition, which has the characteristics of a Complex Adaptive System. 2, from the complex aetiology of dental anomalies it is the general environmental factors that are possible initial targets in seeking to reduce the burden of treatment need. 3, programmes to address dental anomalies should be part of, and can contribute to, strategies to reduce oral and general health inequalities.