The Global Prevalence and Severity of Dental Caries among Racially Minoritized Children: A Systematic Review and Meta-Analysis

Abstract

Racially minoritized children often bear a greater burden of dental caries, but the overall magnitude of racial gaps in oral health and their underlying factors are unknown. A systematic review and meta-analysis were conducted to fill these knowledge gaps. We compared racially minoritized (E) children aged 5–11 years (P) with same-age privileged groups (C) to determine the magnitude and correlates of racial inequities in dental caries (O) in observational studies (S). Using the PICOS selection criteria, a targeted search was performed from inception to December 1, 2021, in nine major electronic databases and an online web search for additional grey literature. The primary outcome measures were caries severity, as assessed by mean decayed, missing, and filled teeth (dmft) among children and untreated dental caries prevalence (<i>d</i> > 0%). The meta-analysis used the random-effects model to calculate standardized mean differences (SMD) and 95% confidence intervals (95% CI). Subgroup analysis, tests for heterogeneity (<i>I</i><sup>2</sup>, Galbraith plot), leave-one-out sensitivity analysis, cumulative analysis, and publication bias (Egger’s test and funnel plots) tests were carried out. The New Castle Ottawa scale was used to assess risk of bias. This review was registered with PROSPERO, CRD42021282771. A total of 75 publications were included in the descriptive analysis. The SMD of dmft score was higher by 2.30 (95% CI: 0.45, 4.15), and the prevalence of untreated dental caries was 23% (95% CI: 16, 31) higher among racially minoritized children, compared to privileged groups. Cumulative analysis showed worsening caries outcomes for racially marginalized children over time and larger inequities in dmft among high-income countries. Our study highlights the high caries burden among minoritized children globally by estimating overall trends and comparing against factors including time, country, and world income. The large magnitude of these inequities, combined with empirical evidence on the oral health impacts of racism and other forms of oppression, reinforce that oral health equity can only be achieved with social and political changes at a global level.

Dental divisions: exploring racial inequities of dental caries amongst children

“…A detailed, systematic study selection was adopted 1 . The study’s data extraction and synthesis methods employed qualitative and quantitative analyses with appropriate subgroup analyses 2 and sensitivity tests 3 , 4 . The results provided clear, quantifiable disparities in dental caries among racially minoritised children, particularly in high-income countries with a growing trend over time.…”

School-based caries prevention using silver diamine fluoride: A pragmatic randomized trial in low-income rural children

“…This inequity largely persists today, with those living in rural areas facing lower access to dental care 6 and being less likely to have dental insurance 7 , 8 . As a result, these populations are disproportionately affected by caries and other oral diseases 9 , 10 .…”

“…This inequity largely persists today, with those living in rural areas facing lower access to dental care 6 and being less likely to have dental insurance 7,8 . As a result, these populations are disproportionately affected by caries and other oral diseases 9,10 . In recognition of these needs, the World Health Organization’s Global Oral Health Action Plan includes calls for evidence-based interventions to prevent oral diseases, innovative workforce models for oral health, and increased access to essential curative oral health care 11 .…”

Reliability of impedance spectroscopy versus digital radiograph and ICDAS-II in occlusal caries detection: a prospective clinical trial

“…Although dental caries remains the most widely spread chronic disease in both children and adults, it is largely preventable. According to the Global Burden of Disease Study, dental caries is considered as a one of the most common preventable non-communicable diseases globally, with an estimated 2.5 billion people affected and a 14.6% increase in dental caries over 10 years 1 . Molars and premolars are the most vulnerable teeth to caries attack related to the morphology and the difficulty of plaque removal 2 .…”