Global prevalence of edentulism in the over 45s

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A 2020 United Nations report estimated the global population of people over the age of 65 to stand at 703 million and be expected to double in the next 30 years and those over the age of 80 to triple by 2050 from its current level of 143 million. Improvements in oral health mean that more people are retaining their teeth and rates of edentulism declining leading to a rise in the susceptibility to dental caries and periodontal disease. Having good oral health before physical health declines and dependency arises and makes it more challenging to maintain oral health is important as is having good data to help plan services.

The aim of this review was to summarise the global data on the prevalence of edentulism and dental caries of people aged ≥45 years living in the community.

Methods

A protocol was registered with the PROSPERO database, and searches conducted on the Medline/PubMed, Embase, Scopus and OpenGrey databases. Observational studies (cross-sectional studies, case-control studies and cohort studies, questionnaire/survey studies) in community dwelling adults aged ≥ 45 years published since 2005 were considered. Two reviewers independently screened and selected studies with data extraction and quality assessment being undertaken by 3 groups of researchers with a random 10% checked for reliability. A customised version of the National Heart, Lung and Blood Institute for Observational Cohort and Cross-sectional studies, Case-Control studies and Controlled-Intervention studies tool was used for quality assessment. Scores of 0–6  = poor quality, 7–10 fair quality, and 11–14 good quality. A search for National oral health surveys (NOHS) published since 2010 was also conducted.

Only studies with a cross-sectional or longitudinal design, reporting the final sample size, mean or median age, and the proportion of individuals who were edentulous and/or who had dental caries (reported as the number/percentage of individuals with active dental caries) were included in the meta-analysis. 3 age groups were categorised:45–64 years, 65–74 years, ≥75 years. Countries were divided in five different regions: Africa, North America, South America, Asia-Oceania, Europe. The Gross National Income (GNI per capita) was used as a measure of the socioeconomic status of a country and reported in US dollars using five categories <$15,000, $15,000–30,000, $30,000-$45,000, $30,000-$45,000, >$45,000:

Results

  • 86 studies (69 cross-sectional, 16 longitudinal, 1 case-control) were included
  • 53 studies were from Asia-Oceania, 13-Europe, 10-South America, 5-North America and 1 from Africa and 4 studies presented data from two countries in two different regions.
  • 21 studies were considered to be of good quality 58 of fair quality, and 7 of poor quality.
  • 17 NOHS were included, 4 from Africa, 3 – Asia-Oceania, 4- Europe, 2- North America, 4- South America.
  • Prevalence of edentulism ranged from 1.1% to 70%.
  • Dental caries prevalence ranged from 4.9% to 98%.
  • Pooled prevalence of edentulism and dental caries is shown in tables below
Region Pooled prevalence of edentulism (95% CIs) Pooled prevalence of dental caries (95% CIs)
North America 11% (8 to 14%) 29% (26 to 33%)
Asia-Oceania 16% (13 to 18%) 55% (41 to 70%)
South America 37% (24 to 49%) 42% (27 to 57%)
Europe 28% (21 to 49%) 19% (9 to 30%)
Africa No data 48% (38 to 58%)
Global 22% (19 to 24%) 45% (28 to 62%)

 

Age Groups Pooled prevalence of edentulism (95% CIs) Pooled prevalence of dental caries (95% CIs)
45–64 9% (7 to 12%) 46% (30 to 61%)
65–74 21% (17 to 26%) 48% (22 to 74%)
≥75 27% (19 to 34%) 34% (23 to 63%)
Overall 22% (19 to 24%) 44% (25 to 63%)

 

Gross National Income (GNI) Pooled prevalence of edentulism (95% CIs) Pooled prevalence of dental caries (95% CIs)
<$15,000 32% (15 to 49%) 53% (31 to 75%)
$15,000 – $30,000 16% (13 to 20%) 47% (26 to 67%)
$30,000 – $45,000 23% (19 to 27%) No data
>$45,000 20% (15 to 26%) 29% (25 to 62%)

Conclusions

The authors concluded: –

6 results indicate that untreated dental caries and edentulism are still very much prevalent on a global level. The oral health status of older populations is highly heterogeneous, and comparisons need to consider the complexity of individual realities.

Comments

The recently published WHO Global Oral Health Status Report highlights that untreated oral diseases affect more than half the world’s population with case numbers having increased by over a billion in the pat 30 years.  This review focuses on the two issues of edentulism and caries in adults aged 45 and over. The authors have followed a pre-registered protocol and searched a good range of databases identifying 86 studies and 17 NOHS. The data provides a helpful estimate of both edentulism and dental caries however not all countries are represented and in some regions only a limited number of countries provided data so limiting the level of representation. Data collected in some studies may only be representative of the area in which the data was collected and not of the whole country or region.  Most of the included studies did not undertake sample size or power calculation. The studies demonstrate marked variation between regions and countries and within countries and this together with the limitations of the data needs to be taken into consideration when interpreting the data.

For those with a broader interest in the impact of oral health and the challenges it presents the WHO Global Oral Health Status Report is recommended.

Links

Primary Paper

Borg-Bartolo R, Roccuzzo A, Molinero-Mourelle P, Schimmel M, Gambetta-Tessini K, Chaurasia A, Koca-Ünsal RB, Tennert C, Giacaman R, Campus G. Global prevalence of edentulism and dental caries in middle-aged and elderly persons: A systematic review and meta-analysis. J Dent. 2022 Dec;127:104335. doi: 10.1016/j.jdent.2022.104335. Epub 2022 Oct 17. PMID: 36265526.

Review protocol on PROSPERO

Other references

WHO Global Oral Health Status Report – 18th – Nov 2022

 

 

 

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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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