Global Burden of Oral Conditions in 1990-2010

The WHO Global Oral Health Action Plan has set an overarching global target of achieving a 10% reduction in the prevalence of oral conditions by 2030. Robust and up-to-date information on the global burden of oral conditions is paramount to monitor progress towards this target. The aim of this systematic data analysis was to produce global, WHO region, and country-level estimates of the prevalence of, and disability-adjusted life-years (DALYs) attributed to, untreated caries, severe periodontitis, edentulism, other oral disorders, lip and oral cavity cancer, and orofacial clefts from 1990 to 2021. This report is based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. Input data were extracted from epidemiological surveys, population-based registries, and vital statistics. Data were modelled with DisMod-MR 2.1, a Bayesian meta-regression modelling tool, to ensure consistency between prevalence, incidence, remission, and mortality estimates for oral conditions. DALYs were estimated as the aggregation of the years of life lost (YLLs) due to premature mortality and years lived with disability (YLDs). YLDs were calculated by multiplying prevalence estimates, the severity of the oral condition's sequelae (disability weight) and duration of the sequelae. Although all oral conditions lead to YLDs, only lip and oral cavity cancer and orofacial clefts lead to YLLs as well. 95% uncertainty intervals (UIs) were generated for every metric with the 25th and 975th ordered 1000 draw values of the posterior distribution. The combined global age-standardised prevalence of the main oral conditions (untreated caries, severe periodontitis, edentulism, and other oral disorders) was 45 900 (95% UI 42 300 to 49 800) per 100 000 population in 2021, with 3·69 billion (3·40 to 4·00) people affected globally. Untreated dental caries of permanent teeth and severe periodontitis were the most common oral conditions, with a global age-standardised prevalence of 27 500 (24 000 to 32 000) per 100 000 population and 12 500 (10 500 to 14 500) per 100 000 population, respectively. Edentulism, severe periodontitis, and lip and oral cavity cancer caused the highest burden as demonstrated by their counts of DALYs and age-standardised DALY rates. Existing trends for 1990-2021 reveal relatively small changes (upward or downward) in prevalence and burden. Increasing counts of prevalent cases and DALYs were noted for all oral conditions but untreated caries of deciduous teeth (no percentage change in prevalence or DALYs) and orofacial clefts (-68·3% [-79·3 to -46·5] decrease in DALYs). There were decreases in both age-standardised prevalence and DALY rate for untreated caries of permanent teeth and edentulism, no change in both for untreated caries of deciduous teeth and severe periodontitis, an increase in the prevalence but no change in the DALY rate for lip and oral cavity cancer, and no change in the prevalence but a decrease in the DALY rate for orofacial clefts. By WHO region, the African and Eastern Mediterranean regions showed the largest increases in prevalent cases and DALYs for most oral conditions, while the European region showed the smallest increases or no change. The European region was the only region with decreasing age-standardised prevalence of untreated caries in both deciduous (-9·88%; -12·6 to -6·71) and permanent teeth (-5·94% (-8·38 to -3·62). The prevalence and DALY rate of severe periodontitis decreased in the African region, while the prevalence and DALY rate of edentulism decreased in the African region, South-East Asia region, and Western Pacific region. Furthermore, DALY rates of lip and oral cavity cancer decreased in the European region and the region of the Americas, while DALY rates of orofacial clefts decreased in all regions. The minor changes in the burden of oral conditions over the past 30 years demonstrate that past and current efforts to control oral conditions have not been successful and that different approaches are needed. Many countries now face the double challenge of controlling the occurrence of new cases of oral conditions and addressing the huge unmet need for oral health care. Bill & Melinda Gates Foundation.

Medline, Embase, Lilacs. Published and unpublished observational population-based studies presenting information on the prevalence, incidence, case fatality and cause-specific mortality related to untreated caries, severe periodontitis and severe tooth loss between January 1980 and December 2010. There were no language restrictions. Study quality was assessed using the STROBE checklist (http://www.strobe-statement.org/). Prevalence estimates were calculated on the database for all age-gender-country-year groups using a specifically developed Bayesian meta-regression tool. Disability-adjusted life-years (DALYs) and years lived with disability (YLDs) metrics were used to quantify the disease burden. Disability weights were calculated based on population-based surveys in five countries (USA, Peru, Tanzania, Bangladesh and Indonesia) and an open Internet survey. Uncertainties in estimates were examined using Monte Carlo simulation techniques with uncertainty levels presented as the 2.5th and 97.5th centiles, which can be interpreted as a 95% UI. Oral diseases remain highly prevalent in 2010 affecting 3.9 billion people. Untreated caries in permanent teeth was the most prevalent condition evaluated for the entire GBD (Global Burden of Disease) 2010 Study with a global prevalence of 35% for all ages combined. Severe periodontitis and untreated caries in deciduous teeth were the 6th and 10th most prevalent conditions, affecting, respectively, 11% and 9% of the global population. Oral conditions combined accounted for 15 million DALYs globally (1.9% of all YLDs and 0.6% of all DALYs), implying an average health loss of 224 years per 100,000 people. DALYs due to oral conditions increased 20.8% between 1990 and 2010, mainly due to population growth and aging. While DALYs due to severe periodontitis and untreated caries increased, those due to severe tooth loss decreased. The findings highlight the challenge in responding to the diversity of urgent oral health needs world-wide, particularly in developing communities.

ABSTRACTAimTo (i) assess the prevalence, incidence, and burden of lip and oral cavity cancer, untreated caries, and “other oral conditions” (a group that includes temporomandibular disorders, malocclusion, and dental trauma, among others) in 2021; and (ii) forecast their estimates in 2050. Aggregate estimates for overall oral conditions (comprising caries, periodontitis, and edentulism, but excluding cancer) were also evaluated.MethodsPrevalence, incidence, Years Lived with Disability (YLDs), Years of Life Lost (YLLs), Disability‐Adjusted Life Years (DALYs), and deaths were reported for lip and oral cavity cancer. Untreated caries and “other oral conditions” were described as prevalence and YLDs, with incidence included only for caries. Aggregate estimates for overall oral conditions encompassed prevalence, incidence, and YLDs. Data were gathered globally, covering 204 countries, seven super‐regions, and 21 regions from the Global Burden of Disease (GBD) study in 2021, with projections up to 2050 using mixed‐effects models.ResultsIn 2021, over 1.54 million (95% UI 1.44; 1.63) people worldwide were affected by lip and oral cavity cancer, with a global age‐standardized prevalence of 0.02%. The burden included 1.28 YLDs per 100 000 (0.97; 1.59), 65.86 YLLs per 100 000 (59.53; 71.00), 67.71 DALYs per 100 000 (61.32; 73.17), and 2.42 deaths per 100 000 (2.21; 2.60). By 2050, prevalence and incidence are projected to increase by +68.7% and + 82.6%, respectively. By that time, lip and oral cavity cancer is expected to rank 119th in terms of YLDs. In 2021, 7.55% (6.29–8.78) of children had untreated caries in deciduous teeth, 27.54% (23.98–32.02) of the adult population had caries in permanent teeth, and 1.86% (1.78–1.93) were affected by “other oral conditions”, with 45.91% (42.26–49.78) of the global population experiencing at least one oral condition. By 2050, the prevalence of deciduous caries is projected to decrease by −15.80%, while permanent caries is predicted to rise by +23.77%, and “other oral conditions” will increase by +22.28%. Overall oral conditions (including periodontitis and edentulism, but excluding cancer) are projected to affect 46.17% (42.52–49.95) of the global population in 2050, ranking as the 10th leading cause of YLDs, surpassing conditions such as stroke and Alzheimer's disease.ConclusionLip and oral cavity cancer, along with oral conditions aggregated (caries, periodontitis, edentulism, “other oral conditions”), continued to pose significant public health challenges in 2021, with the number of affected individuals expected to increase substantially in the coming decades, largely driven by rising estimates of edentulism and severe periodontitis.

Health in 2020 and beyond: what do the numbers tell us?

A Global Perspective on the Burden of Caries in Permanent Teeth in China (1990-2021): A Population-Based Analysis.

ABSTRACTObjectiveThis study aims to analyze the burden of untreated caries in deciduous and permanent teeth in China from 1990 to 2019 and projects its future trends through 2039.Materials and MethodsData on the burden of caries in primary and permanent teeth in China between 1990 and 2019 were extracted from the Global Burden of Disease 2019 study to assess the current burden of untreated caries. The average annual percentage change (AAPC) was estimated using a joinpoint regression model to evaluate temporal trends in the burden of untreated caries. A Bayesian age–period–cohort model was applied to project the burden of untreated caries between 2019 and 2039.ResultsFrom 1990 to 2019, the age‐standardized incidence rate (ASIR) of untreated caries in deciduous teeth in China increased by 6.8%, with an AAPC of 0.22 (95% confidence interval [95% CI]: 0.15–0.22, p < 0.05). The ASIR of caries in permanent teeth decreased by 1.3%, with an AAPC of −0.05 (95% CI: −0.04 to −0.05, p < 0.05). The highest incidence of caries in primary teeth was observed in the 0–4 age group, whereas the highest ASIR of caries in permanent teeth was observed in the 20–24 age group. No significant sex differences were found in the incidence rates of caries in either dentition. Projections from 2020 to 2039 indicate an upward trend in the ASIR of caries in both deciduous and permanent teeth.ConclusionsOver the past 30 years, the burden of dental caries in China has increased significantly. Projections indicate that the ASIR of dental caries will continue to increase. Therefore, appropriate prevention and control strategies are required to reduce the burden of caries in the Chinese population.

Government and nongovernmental organizations need national and global estimates on the descriptive epidemiology of common oral conditions for policy planning and evaluation. The aim of this component of the Global Burden of Disease study was to produce estimates on prevalence, incidence, and years lived with disability for oral conditions from 1990 to 2017 by sex, age, and countries. In addition, this study reports the global socioeconomic pattern in burden of oral conditions by the standard World Bank classification of economies as well as the Global Burden of Disease Socio-demographic Index. The findings show that oral conditions remain a substantial population health challenge. Globally, there were 3.5 billion cases (95% uncertainty interval [95% UI], 3.2 to 3.7 billion) of oral conditions, of which 2.3 billion (95% UI, 2.1 to 2.5 billion) had untreated caries in permanent teeth, 796 million (95% UI, 671 to 930 million) had severe periodontitis, 532 million (95% UI, 443 to 622 million) had untreated caries in deciduous teeth, 267 million (95% UI, 235 to 300 million) had total tooth loss, and 139 million (95% UI, 133 to 146 million) had other oral conditions in 2017. Several patterns emerged when the World Bank’s classification of economies and the Socio-demographic Index were used as indicators of economic development. In general, more economically developed countries have the lowest burden of untreated dental caries and severe periodontitis and the highest burden of total tooth loss. The findings offer an opportunity for policy makers to identify successful oral health strategies and strengthen them; introduce and monitor different approaches where oral diseases are increasing; plan integration of oral health in the agenda for prevention of noncommunicable diseases; and estimate the cost of providing universal coverage for dental care.

IntroductionUntreated dental caries remains a significant global public health challenge, disproportionately affecting vulnerable populations and highlighting inequalities in health systems worldwide. Examining its distribution across diverse contexts is essential for guiding targeted interventions, informing public policies, and allocating resources more effectively. This study aims to provide a comprehensive global assessment of the distribution of untreated dental caries in 204 countries and territories, spanning the years 2000, 2010, and 2019, by dimensions of structural determinants of health.MethodsThis study employs an ecological design. This analysis describes the incidence, prevalence and years lived with disability (YLDs) due to untreated dental caries in permanent and deciduous teeth by structural determinants of health (dimensions of governance, macroeconomic policy, social policy, public policies and culture/societal values), for 204 countries and territories. Estimates of untreated caries in deciduous teeth by structural determinants were reported for children under 5 years of age, whereas estimates in permanent teeth were described for adolescents and adults aged between 15 and 49 years. Estimates were retrieved from the Global Health Data Exchange.ResultsThere was a gradient of inequality between countries in terms of prevalence, YLDs, and the incidence of overt untreated caries. Countries that had better structural indicators had lower mean prevalence of untreated caries in primary teeth. In the permanent dentition, between-countries inequalities were not identified. Additionally, the mean prevalence was stable from 2010 to 2019.ConclusionsThis study revealed possible cross-country inequalities in the burden of untreated caries in deciduous teeth that persisted over one decade. More developed countries experienced less disease burden. These findings show the need for targeted interventions to address the uneven burden of untreated dental caries worldwide.Clinical significanceThis study underscores the need for targeted global health policies to reduce untreated dental caries, especially in countries with lower structural health determinants, highlighting cross-country inequalities in disease burden and the importance of addressing these disparities in both primary and permanent dentition.

Untreated dental caries remains a significant global public health challenge, disproportionately affecting vulnerable populations and highlighting inequalities in health systems worldwide. Examining its distribution across diverse contexts is essential for guiding targeted interventions, informing public policies, and allocating resources more effectively. This study aims to provide a comprehensive global assessment of the distribution of untreated dental caries in 204 countries and territories, spanning the years 2000, 2010, and 2019, by dimensions of structural determinants of health. This study employs an ecological design. This analysis describes the incidence, prevalence and years lived with disability (YLDs) due to untreated dental caries in permanent and deciduous teeth by structural determinants of health (dimensions of governance, macroeconomic policy, social policy, public policies and culture/societal values), for 204 countries and territories. Estimates of untreated caries in deciduous teeth by structural determinants were reported for children under 5 years of age, whereas estimates in permanent teeth were described for adolescents and adults aged between 15 and 49 years. Estimates were retrieved from the Global Health Data Exchange. There was a gradient of inequality between countries in terms of prevalence, YLDs, and the incidence of overt untreated caries. Countries that had better structural indicators had lower mean prevalence of untreated caries in primary teeth. In the permanent dentition, between-countries inequalities were not identified. Additionally, the mean prevalence was stable from 2010 to 2019. This study revealed possible cross-country inequalities in the burden of untreated caries in deciduous teeth that persisted over one decade. More developed countries experienced less disease burden. These findings show the need for targeted interventions to address the uneven burden of untreated dental caries worldwide. This study underscores the need for targeted global health policies to reduce untreated dental caries, especially in countries with lower structural health determinants, highlighting cross-country inequalities in disease burden and the importance of addressing these disparities in both primary and permanent dentition.

INTRODUCTION Epidemiological surveys revealed that Brazil has a high burden of oral diseases. However, no prior study has reported estimates of untreated dental caries, periodontitis, and edentulism over a three-decade period. The objective of this study is to report the trends of prevalence, incidence, and years-lived with disability (YLDs) due to untreated dental caries in primary and permanent teeth, periodontitis, and edentulism in Brazil between 1990 and 2019. METHODS Estimates of prevalence, incidence, and YLDs due to dental caries in primary and permanent teeth, periodontitis, and edentulism were produced for Brazil, by sex and age, between 1990 and 2019, using Dismod-MR 2.1, as part of the Global Burden of Disease Study 2019 (GBD 2019). Trends of oral disorders were analyzed using generalized linear regression models applying the Prais-Winsten method. RESULTS Almost 100 million Brazilians presented at least one oral disorder in 2019, which was equivalent to a prevalence of 45.3%. All oral diseases combined ranked eighth among all causes of disability, causing more than 970,000 YLDs. Untreated dental caries in primary teeth were estimated to affect 13.5 million children, and untreated dental caries in permanent teeth affected more than 52 million people. Periodontitis affected 29.5 million people, and edentulism affected almost 22 million. The generalized linear regression models revealed a trend of stability of oral disorders between 1990 and 2019.CONCLUSIONS The burden of oral diseases in Brazil is extremely high. Oral disorders, edentulism in particular, caused disability at levels that are comparable to other important chronic diseases.

We aimed to consolidate all epidemiologic data about untreated caries and subsequently generate internally consistent prevalence and incidence estimates for all countries, 20 age groups, and both sexes for 1990 and 2010. The systematic search of the literature yielded 18,311 unique citations. After screening titles and abstracts, we excluded 10,461 citations as clearly irrelevant to this systematic review, leaving 1,682 for full-text review. Furthermore, 1,373 publications were excluded following the validity assessment. Overall, 192 studies of 1,502,260 children aged 1 to 14 y in 74 countries and 186 studies of 3,265,546 individuals aged 5 y or older in 67 countries were included in separate metaregressions for untreated caries in deciduous and permanent teeth, respectively, using modeling resources from the Global Burden of Disease 2010 study. In 2010, untreated caries in permanent teeth was the most prevalent condition worldwide, affecting 2.4 billion people, and untreated caries in deciduous teeth was the 10th-most prevalent condition, affecting 621 million children worldwide. The global age-standardized prevalence and incidence of untreated caries remained static between 1990 and 2010. There is evidence that the burden of untreated caries is shifting from children to adults, with 3 peaks in prevalence at ages 6, 25, and 70 y. Also, there were considerable variations in prevalence and incidence between regions and countries. Policy makers need to be aware of a predictable increasing burden of untreated caries due to population growth and longevity and a significant decrease in the prevalence of total tooth loss throughout the world from 1990 to 2010.

Global and regional trends in prevalence of untreated caries in permanent teeth: Age-period-cohort analysis from 1990 to 2019 and projections until 2049

Trends in the Burden of Untreated Caries of Permanent Teeth in China, 1993–2017: An Age–Period–Cohort Modeling Study

BackgroundEarly childhood caries (ECC) is a type of dental caries in the teeth of infants and children that is represented as one of the most prevalent dental problems in this period. Various studies have reported different types of prevalence of dental caries in primary and permanent teeth in children worldwide. However, there has been no comprehensive study to summarize the results of these studies in general, so this study aimed to determine the prevalence of dental caries in primary and permanent teeth in children in different continents of the world during a systematic review and meta-analysis.MethodsIn this review study, articles were extracted by searching in the national and international databases of SID, MagIran, IranMedex, IranDoc, Cochrane, Embase, ScienceDirect, Scopus, PubMed, and Web of Science (ISI) between 1995 and December 2019. Random effects model was used for analysis and heterogeneity of studies was evaluated by using the I2 index. Data were analyzed by using the Comprehensive Meta-Analysis (Version 2) software.FindingsIn this study, a total of 164 articles (81 articles on the prevalence of dental caries in primary teeth and 83 articles on the prevalence of dental caries in permanent teeth) were entered the meta-analysis. The prevalence of dental caries in primary teeth in children in the world with a sample size of 80,405 was 46.2% (95% CI: 41.6–50.8%), and the prevalence of dental caries in permanent teeth in children in the world with a sample size of 1,454,871 was 53.8% (95% CI: 50–57.5%). Regarding the heterogeneity on the basis of meta-regression analysis, there was a significant difference in the prevalence of dental caries in primary and permanent teeth in children in different continents of the world. With increasing the sample size and the year of study, dental caries in primary teeth increased and in permanent teeth decreased.ConclusionThe results of this study showed that the prevalence of primary and permanent dental caries in children in the world was found to be high. Therefore, appropriate strategies should be implemented to improve the aforementioned situation and to troubleshoot and monitor at all levels by providing feedback to hospitals.

ObjectivesWe aimed to analyze the trends of untreated caries in permanent teeth in Asia over the past 30 years, identify high‐risk groups and areas of high prevalence, and explore strategies to mitigate this disease burden.MethodsData were extracted from the Global Burden of Disease (GBD) Database. The incidence, prevalence, years lived with disability (YLDs), and age‐standardized incidence rate (ASIR), age‐standardized prevalence rate (ASPR), and age‐standardized YLD rate (ASYR) were analyzed. Spatial and temporal distributions of untreated caries in permanent teeth were also determined.ResultsFor Asia, the crude incidence, prevalence, and YLDs showed increasing trends; ASIR remained constant; and ASPR and ASYR demonstrated decreasing trends. In 2019, the incidence and prevalence of untreated caries in permanent teeth peaked in the 20–24‐year age group. The spatial “hot spots” for ASIR were South and East Asia, whereas the “cold spots” were West and Central Asia. The hot spots for ASPR and ASYR were in West Asia, whereas the cold spots were in East Asia.ConclusionsUntreated caries in permanent teeth demonstrated significant geographical and demographic differences in Asia, revealing a relevant public health challenge. Intervention strategies based on dynamic changes are required to reduce the burden of dental caries in this region.