Global Burden and Inequality of Caries in Deciduous Teeth

Objectives: Although dental caries is largely preventable, burden of caries in deciduous teeth remains a major public health concern worldwide. Lack of up-to-date epidemiological data has been identified as a key barrier to effective implementation of global oral health policies. We aimed to investigate trends of incident cases of untreated caries in deciduous teeth worldwide during 1990-2019 with a focus on the drivers and inequality of caries burden.
Methods: Data on the number and age-standardized rate of incident cases of untreated caries in deciduous teeth were extracted from the Global Burden of Disease Study 2019. Decomposition analysis was performed to ascertain the relative contribution of demographic and epidemiological factors to the changing number of incident caries cases during 1990-2019. Sociodemographic attribution analysis was performed to determine the number and proportion of incident caries cases attributable to cross-country sociodemographic inequality globally in 2019.
Results: In 2019, there were 1.2 billion (95% Uncertainty Interval 0.8-1.5) incident cases of untreated caries in deciduous teeth worldwide with an age-standardised incidence rate of 168161.4 (11606.7-22271.0) per 100000 person-years. Regionally, the largest increase in age-standardised incidence rate was noted in the High Income region (6.1%, 0.1%-9.9%). The contribution of population growth to the increased number of caries cases during 1990-2019 corresponded to 12.3% of the caries cases in 1990 globally and 106.1% in Sub-Saharan Africa. Globally, 84.5 (84.2-84.7) million caries cases, equivalent to 7.3% (7.3%-7.4%) of all cases, were attributable to inequality in sociodemographic development status in 2019, which translated to 2.7 (95% Confidence Interval 2.7-2.7) incident cases per second.
Conclusions: Population growth is the key driver of the increasing incident cases of caries in deciduous teeth during 1990-2019 globally and most notably in Sub-Saharan Africa. Inequality in caries burden calls for an urgent need to prioritise interventions that address upstream determinants of dental caries.