Caries prevalence and experience in older adults

The authors managed to develop and implement a strategy to reach older adults in rural areas, despite various barriers to access mental health treatment for this population.

Dental caries is the world’s commonest disease affecting children and adults alike. While dental caries is a preventable disease it is the fourth most expensive disease to treat and places biological financial and social burdens on health care systems and societies.   It has been estimated that by 2039 around one in six people will be aged 65 or more and with an increasing life expectancy people retain their tooth longer increasing their caries risk. Surveys provide information for the surveillance of disease patterns and trends to assist planning and policy development.

The aim of this review was to explore recent information on the caries prevalence and experience of older adults globally.

Methods

Searches were conducted in the Pubmed, Scopus, Embase Web of Science and Google Scholar from January 2016 to December 2020. Epidemiological surveys investigating caries or root caries prevalence; and baseline findings from longitudinal studies involving adults aged 60 or above and published in English were considered. Two reviewers independently searched for and selected studies, extracted data and assessed quality using the JBI Critical Appraisal Checklist for studies reporting prevalence data.

Results

  • 39 studies were included.
  • 17 studies were considered to be of good quality and 22 of moderate quality.
  • Studies were conducted over 6 continents and 20 countries, India [8], China [6], Turkey [3], Australia [2], Germany [2], Mexico [2], Poland [2] and one each in Brazil, Egypt, Finland, Ireland, Kosovo, Malawi, Norway, Portugal, Romania, Singapore, South Africa, USA and
  • 28 of the 39 studies (72%) were conducted in the community setting the rest in residential or care homes.
  • 33 studies reported untreated caries status, and 11 root caries status.
  • The WHO criteria were used for the majority of studies (33 out of 39).
  • The prevalence of untreated caries ranged from: –
    • 25% (Australia) to 99% (South Africa) in community dwelling older adults.
    • 47% (India) to 99% (Vietnam) in Institutionalised older adults.
  • The prevalence of untreated root caries ranged from: –
    • 8% (Finland) to 74% (Brazil) in community dwelling older adults.
    • 30% (Hong Kong) to 96% (Vietnam) in institutionalised older adults.
  • The global median of mean DMFT score was 21.9 (range 6.9 to 29.7).
  • The median of mean prevalence for caries and root caries by continent are shown in the table below.
  No. of countries (studies) Caries prevalence Root caries prevalence
Africa 3 (3) 49%
America – North 2 (3) 25% 95.3%
America – South 1 (1) 74%
Asia 5 (20) 66% 46%
Europe 8 (10) 46% 35%
Oceania 1 (2) 25% 18%
Global 20 (39) 49% 46%

Conclusions

The authors concluded: –

Based on the included studies published in the past 5 years (2016–2020), the prevalence of caries in older adults was still high in most countries around the globe. The health policy makers should have better planning to relieve the increasing global burden of caries from the surging older adult population in the coming decade.

Comments

This review has focused on recent data regarding caries prevalence and experience in people aged 60 or older restricting their database searching to studies published between 2016-2020. A protocol was published on PROSPERO and a good range of databases was searched although inclusion was restricted to studies published in English. As the author’s note in their discussion this may have excluded some relevant studies. The authors also highlight the limited number of studies in this age group from some continents and the facts that some of the studies are local or regionally based rather than national with some having small sample sizes. Medians rather than means of prevalence and DMFT score were reported an no meta-analyses were conducted of heterogeneity in the included studies. While a global prevalence of untreated caries and root caries in the high 40s percentage points caries remains an important public health problem in this population grou. Consequently,  oral health promotion and education and preventive treatments across the complete lifespan are necessary to help address this preventable disease.

Links

Primary Paper

Chan AKY, Tamrakar M, Jiang CM, Lo ECM, Leung KCM, Chu CH. A Systematic Review on Caries Status of Older Adults. Int J Environ Res Public Health. 2021 Oct 12;18(20):10662. doi: 10.3390/ijerph182010662. PMID: 34682414; PMCID: PMC8535396.

Review protocol on PROSPERO

Other references

Dental Elf – 22nd  Aug 2018

Root Caries: Incidence and increment

Dental Elf – 9th Mar 2015

Untreated caries: a significant global problem

 

 

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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. He is a former editor of the Evidence-Based Dentistry Journal, the chief blogger for the Dental Elf website and a past president of the British Association for the Study of Community Dentistry. He has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Retired from the NHS he is currently a part-time senior lecturer at Dundee Dental School.

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