Cavities, gingivitis and tooth loss surpass other illnesses affecting 308 million in Latin America and the Caribbean

Oral diseases, the vast majority of which are preventable, are the most common health condition in Latin America and the Caribbean, maintaining this prominent position for at least three decades. In the year 2023, a recent survey shows that cavities, advanced gum disease and the complete absence of teeth will affect a contingent of 308.2 million individuals in the region, exceeding the incidence of any other disease, according to data published in the renowned scientific journal The Lancet Regional Health – Americas.

This extensive research work is part of the Global Burden of Disease Study (GBD), an initiative coordinated by the Institute for Health Metrics and Evaluation (IHME), linked to the University of Washington, in the United States, and which has financial support from the Gates Foundation.

The analysis included estimates from 33 nations, covering the period from 1990 to 2023, and also presents projections for the year 2050. The study was coordinated by epidemiologist Rafael Lozano, and included the valuable collaboration of Brazilian researchers.

In the universe of all diseases and health conditions catalogued, oral issues consistently led the prevalence rate — which refers to the number of people living with the condition at a given time — in the years 1990, 2000 and 2023, showing a worrying persistence.

In the most recent year of analysis, these conditions were responsible for 53.7% of all ongoing health problems in the area studied, exceeding half of the total. In relation to the emergence of new cases each year, oral diseases occupied the third position, behind only upper respiratory tract infections and Covid-19. Before the outbreak of the pandemic, they were in second place.

Despite a modest reduction in the number of new cases recorded over the period, the incidence and limitations associated with these health problems have remained practically unchanged since 1990. For those responsible for the study, this scenario points to the limited effectiveness of preventive approaches and the secondary position that oral health occupies in the region’s public policy priorities.

The transformation of oral diseases throughout the different stages of life

Far from presenting a static scenario, the study reveals that the manifestation of these oral diseases adapts and changes shape as people age.

• In early childhood, there is a predominance of cavities in deciduous (baby) teeth, with a peak occurrence observed between 5 and 9 years of age.
• During youth and adulthood, cavities affecting permanent teeth become more prevalent, with greater frequency between the ages of 40 and 44. At more advanced ages, the incidence of severe periodontitis — an advanced manifestation of gum disease — and edentulism, which corresponds to the total loss of natural teeth, increases.

This age progression has a direct impact on the disability generated. The researchers used the indicator of years lived with disability (AVI) to quantify this effect, which estimates the period that an individual spends living with the restrictions and limitations imposed by a disease.

While cavities in baby teeth barely contribute to this count, edentulism, or the total loss of teeth, emerges as the main factor responsible for the reduction in quality of life in the elderly population. The complete absence of teeth alone was responsible for 1.3 million of the 2.41 million years lived with disability recorded in 2023, which represents more than half of the total impact of oral diseases in the region.

The incidence and patterns of oral diseases in different countries in the region, including Brazil

The burden of these diseases presents significant variations between countries, reflecting pre-existing structural disparities. Among children aged 1 to 9 years, the highest rates of disability resulting from cavities in primary teeth were recorded in Belize and Paraguay. On the other hand, Brazil and Colombia had some of the lowest rates. In the period from 1990 to 2023, nations such as Chile, Argentina and Uruguay achieved reductions of more than 15%, while Mexico, Paraguay and several Central American countries demonstrated little or no progress.

With regard to permanent teeth, the highest rates were identified in Chile, Bolivia and Ecuador, reaching approximately double the values ​​observed in Mexico. Severe periodontitis, meanwhile, has been shown to be most disabling in Bermuda, Puerto Rico, and Uruguay, at nearly double the rates in Guatemala and Honduras, with most countries showing an increase of 25% or more since 1990.

In relation to edentulism, the loss of teeth, Brazil is among the most impacted countries: the highest rates of disability associated with tooth loss in adults aged 60 or over were noted in Bolivia, Peru and Brazil itself. At the opposite end, Chile and Colombia recorded the lowest rates, with reductions of more than 15% over the analyzed period.

One piece of information in particular caught the attention of researchers: nations with greater economic development generally have a lower incidence of total tooth loss, but a greater disability linked to severe periodontitis. This scenario may indicate that, in these locations, a larger portion of the population reaches old age while maintaining their natural teeth, and, consequently, remains exposed to gum disease.

The contradiction between the preventable nature of oral diseases and their persistent neglect

The continued recurrence of this health problem, according to the study, is intrinsically linked to the availability of access to prevention strategies. Where the use of fluoride toothpaste is facilitated and routine dental checkups are accessible, the burden of oral disease tends to be milder.

Countries such as Brazil, Chile, Mexico, Colombia and Peru already implement the supply of fluoride to the majority of their population through toothpaste, water or salt – a tactic recognized for its effectiveness in preventing childhood cavities. However, the prevalence and impact of the disease among adults still remains at high levels.

For researchers, this data highlights the limitations of focusing efforts solely on the application of fluoride, relegating crucial factors such as diet, smoking and the availability of rehabilitative treatments to the background. Deficiencies become even more evident in rural, indigenous and socially excluded population groups, who face inadequate care in both prevention and treatment.

Brazil is highlighted as one of the few nations in the region — alongside Colombia — that maintains continuous and structured monitoring of oral health. In most of the continent, surveillance is still scarce and fragmented, which makes accurate comparisons between countries and the formulation of effective public policies difficult.

Projections and future challenges for oral health in the region until the year 2050

The population aging process in the region is expected to cause a substantial increase in the number of people living with limitations and disabilities resulting from oral health problems. Between 1990 and 2023, the number of years lived with disability almost doubled, from 1.02 million to 2.41 million. The current estimate suggests that this number could reach 3.81 million by 2050, with total tooth loss (edentulism) and severe periodontitis being the main contributors to this increase.

With the aim of changing this trajectory, the study authors advocate the integration of oral health into primary care and universal health coverage. They suggest an approach that accompanies individuals at all stages of life — from childhood to old age. Furthermore, they emphasize the urgency of addressing the social and commercial determinants of the problem, such as high sugar consumption and smoking, through actions that include taxing sugary drinks and tobacco products.

The study, however, recognizes some of its limitations. Of the 33 countries investigated, 14 — mostly located in the Caribbean — did not have primary data available on the topic, which introduces a degree of uncertainty in the estimates presented. Additionally, edentulism was considered only as the total loss of teeth, which may have led to an underestimation of the real impact of partial loss, a common condition among the elderly and capable of significantly compromising chewing and nutrition.