Risk factors for dental caries in Latin American and Caribbean countries

Abstract

Identifying the risk factors for dental caries is vital in epidemiology and clinical practices for developing effective preventive strategies, both, at the individual and collective levels. Different causality/determination models have been proposed to understand the development process of dental caries. In the present review, we designed a model inspired by the world-known social determinants models proposed in the 90s and more recently in the 10s, wherein the contextual factors are placed more externally and encompass the individual factors. The contextual factors included those related to the cultural and societal values, as well as the social and health government policies. The individual factors were classified into the following categories: socioeconomic (social class, occupation, income, and education level), demographic characteristics (age, sex, and ethnicity), behavioral factors (non-use of fluoride dentifrice, sugar consumption, poor oral hygiene, and lack of preventive dental care), and biological factors (recent caries experience/active caries lesions, biofilm retentive factors, developmental defects of the enamel, disabilities, saliva amount and quality, cariogenic biofilm). Each of these variables was addressed, while focusing on the current evidence from studies conducted in Latin American and Caribbean countries (LACC). Based on the proposed model, educational aspects were addressed, and individual caries risk assessment and management decisions were proposed; further, implications for public health policies and clinical practice were described. The identification of modifiable risk factors for dental caries should be the basis for multi-strategy actions that consider the diversity of Latin American communities.

Dental caries prevalence, prospects, and challenges for Latin America and Caribbean countries: a summary and final recommendations from a Regional Consensus

“…1 Caries risk assessment comprises of a range of factors that are not stable and also interact with one another, and a few epidemiological surveys in LACCs investigating some of the main risk factors of dental caries have corroborated the findings of previous systematic reviews. 7 Non-white ethnicity, low educational levels exhibited by the parents, low family income, availability of a health insurance scheme, and old age have been associated with higher dental caries prevalence in the LACC population. 26 Additionally, behavioral risk factors such as a cariogenic diet, high frequency of sugar intake, additional sugar consumption, and poor oral hygiene have also been associated with increased risk of dental caries in this population.…”

“…Other studies carried out in the LACC population demonstrated that the saliva buffering capacity, presence of S. mutans in the saliva, presence of erupting primary and permanent molars, and enamel defects were also related to the prevalence of dental caries. 7 Previous studies have reported that the key risk factors of dental caries can occur at various stages of life. In older people, some factors that indicate a higher risk of caries include exposed root surfaces, increased root caries, gingival recession, poor oral hygiene, and lower socioeconomic levels.…”

“…However, these findings have not been investigated in the LACC population. 7 Potential strategies for preventing and controlling dental caries: summary of articles 3 and 4…”

“…4,5,6 The first paper published from this consensus focused on the burden of dental caries in Latin American and Caribbean countries (LACC), particularly in socioeconom ically deprived populations as dental caries often acts as a marker of social disadvantage, and its effect on the quality of life of the Latin American and Caribbean population. The second article 7 of this consensus explored our understanding of the mechanisms by which risk factors operate in great detail, as much of the available epidemiological evidence from LACCs is inconsistent. 1 Lastly, a lack of robust epidemiological evidence on dental caries can seriously jeopardize the ability to develop effective preventive and restorative strategies for the control of dental caries, and these key themes have been discussed further in articles 3 and 4 of this consensus.…”

Community interventions and strategies for caries control in Latin American and Caribbean countries

“…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 Consequently, teeth that are exposed to periods of demineralization more frequently than remineralization, which is a naturally occurring process, exhibit increased loss of tooth minerals and subsequent development of caries lesions.…”