National Culture and Dental Caries: A Study of 97 Countries

Objectives: to measure the association of country level dental caries prevalence with national culture.
Methods: An ecological study design was used in this study. National statistics on dental caries levels expressed as prevalence for 12-year-old children were obtained from the WHO Oral Health Country/Area Profile Programme (CAPP). Data on national culture was obtained from Hofstede’s model of national culture. This model describes culture using various dimensions; power distance (PDI), individualism (IDV), masculinity (MAS) and uncertainty avoidance (UAI). Controlling for country level sugar consumption, national income (GDP), national income inequality (Gini) and urbanization level a correlation and multivariate regression analysis was done to explore the relationship between country level caries prevalence and national culture.
Results: A data from 97 countries was used in this analysis. Caries prevalence ranged from 4.8% in Australia to 10.8% in Philippines and was significantly correlated with PDI (0.50, 0.001) and IDV (-0.32, 0.001). There was no significant correlation however between caries prevalence and MAS (0.14, 0.17) and UAI (-0.03, 0.76). Multivariate linear regression analysis also showed significant association between caries prevalence, PDI (0.03, 0.001, R²=0.39) and IDV (-0.02,0.001, R²=0.38) - after controlling for national level sugar consumption, national income, national income inequality and urbanization level. Each unit increase in PDI was associated with a corresponding 0.03 unit increase in the caries prevalence while each unit increase in IDV was associated with a 0.02 unit decrease in caries prevalence. However, the association of caries prevalence and MAS and UAI remains non-significant.
Conclusions: Countries with higher power distance culture have significantly higher level of dental caries prevalence. Countries with higher individualist culture have significantly lower level of dental caries. Further studies are required to explore culture as a determinant of dental caries that can help in development of culturally compatible dental public health interventions to reduce dental caries prevalence.