Rheumatic fever in New Zealand: what are the teeth trying to tell us?

Rheumatic fever remains an important disease of childhood in New Zealand, despite increasing access and awareness of the need for preventive antibiotic treatment. Maori and Pacific children have an incidence rate about 30 times and 70 times higher than European children, from annual notification data (77.7 per 100,000 for Pacific, 30.4 per 100,000 for Maori, and 1 per 100,000 for European). In the early 20th century, a Canadian dentist, Weston A. Price, noted that 95% of children who presented with acute rheumatic fever also had advanced dental caries. Oral health surveys show that Maori and Pacific children are disproportionately affected by dental caries compared to European. Excess dietary sugar intake is widely recognised to cause dental decay and also provides energy to some species of bacteria implicated in the pathogenesis of dental decay and rheumatic fever. We suggest that a case-control study be conducted to evaluate the evidence for an association between sugar intake, dental decay and incidence of disease.