Abstract
Dental caries remains highly prevalent in Latin American and Caribbean countries (LACC). However, this disease can be controlled through interventions that implement evidence-based strategies in an affordable manner and that target all population groups instead of the most affluent only. Therefore, the aim of this report was to summarize the main scientifically documented community interventions and strategies based on restriction of sugars consumption, use of fluoride, and the use of occlusal sealants for caries control in LACC. A critical literature review was carried out in a systematic manner that included defined search strategies, independent review of the identified publications, and compilation of results in this report. Three systematic searches were conducted using the PubMed, LILACS, and SciELO databases to identify studies related to community interventions and strategies for caries control in LACC. Of the 37 publications identified, twenty-six focused on fluoride use, eight on occlusal sealant use, and three on the restriction of sugar consumption. Documented community interventions for sugars restriction were scarce in the region and were based on food supplementation, sugar replacement, and education. Thus, local and/or national policies should prioritize investment in upstream, coherent, and integrated population-wide policies such as taxes on sugary drinks and stronger regulation of advertising and promotion of sugary foods and drinks mainly targeting children. The main fluoride-based strategies used drinking water, refined domestic salt, cow milk, toothpaste and, to a lesser extent, mouth-rinses, acidulated phosphate fluoride (APF) gels, and varnishes to deliver fluoride to the population. Evidence of fluoride use was seen in Argentina, Belize, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, El Salvador, Guatemala, Haiti, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Uruguay, and Venezuela. Studies reporting the use of occlusal sealants were mainly located in Brazil, Chile, Colombia, Costa Rica, Peru, Mexico, and Venezuela. Community interventions restricting sugar consumption should be implemented at the individual level and through public policies. The use of fluoride must be monitored at the local, regional, and national levels so as to achieve maximum anti-caries effect while also minimizing the risk of dental fluorosis. Moreover, fluoridated water and salt programs, used as a mutually exclusive community level strategy for caries control, should expand their benefits to reach non-covered areas of the LACC while also simultaneously providing adequate surveillance of the fluoride concentration delivered to the population. Regulating the concentration of soluble fluoride (for anti-caries effect) in dentifrice formulations is also necessary in order to provide the population with an effective strategy for disease control. Targeting culturally appropriate, economically sustainable caries control interventions to rural populations and native ethnic groups such as indigenous people, quilombolas (African-origin), and riverside Amazonian people remains a crucial challenge.
Highlights
Despite rapid advances in the understanding of dental caries and strategies to control it,[1] the disease continues to be highly prevalent in many countries, in Latin American and Caribbean countries (LACC).[2,3] Dental caries occurs due to frequent exposure of the dental biofilm to sugars, highlighting the key role that dietary carbohydrates play in disease onset and progression.[4,5] These sugars are fermented by bacteria present in the biofilm, producing acids that lead to tooth demineralization via a physicochemical process.[6]
Studies reporting strategies based on the restriction of sugar consumption or fluoride use for caries control in at least one Latin American and Caribbean country were included, while those that were of the wrong publication type, did not address the research question, or did not have an abstract available were excluded
The identified studies focusing on interventions using restriction of sugar consumption, fluoride use, or dental sealant as a strategy for caries control in LACC are shown in Tables 1, 2 and 3, respectively
Summary
Despite rapid advances in the understanding of dental caries and strategies to control it,[1] the disease continues to be highly prevalent in many countries, in Latin American and Caribbean countries (LACC).[2,3] Dental caries occurs due to frequent exposure of the dental biofilm to sugars, highlighting the key role that dietary carbohydrates play in disease onset and progression.[4,5] These sugars are fermented by bacteria present in the biofilm, producing acids that lead to tooth (enamel/dentine) demineralization via a physicochemical process.[6]. Sugars play a pivotal role in the development of dental caries as without fermentable carbohydrates, the bacteria are unable to produce acids necessary for tooth demineralization.[4] This suggests that the disease can be controlled, and various community and population-based intervention strategies have been applied to interfere with the de-remineralization process contributing to reduce mineral loss. Methods to control caries based on the restriction of sugar consumption, use of fluoride, and placement of occlusal sealants have been implemented. The strategy based on restriction of sugar consumption aims to reduce the consumption, and focuses on the use of alternative sweetening compounds that are not fermented by bacteria as well as substances with putative anti-caries activity
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