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

Abstract Dental caries can be effectively managed and prevented from developing into cavitated lesions while preserving tooth structure at all levels. However, the strong correlation between caries and socioeconomic factors may compromise the efficacy of preventive strategies. The high prevalence of persistent inequalities in dental caries in Latin American and Caribbean countries (LACC) is a matter of concern. The estimates of the burden of disease in some countries in this region are outdated or absent. This paper aims to summarize and present the final recommendations of a regional Consensus for Dental Caries Prevalence, Prospects, and Challenges for LACC. This consensus is based on four articles that were written by a team of Latin American experts, reviewed by dental associations, and presented and discussed in two consensus events. The following domains were explored: epidemiology, risk factors, prevention strategies, and management of dental caries with a focus on restorative procedures. Dental caries can manifest throughout the lifespan of an individual, making it a matter of concern for infants, children, adults, and older people alike. The prevalence rates of untreated caries in deciduous and permanent teeth are high in many parts of the world, including LACCs. Previous evidence suggests that the prevalence of dental caries in 12-year-olds is moderate to high in most Latin American countries. Moreover, the prevalence of treatment needs and dental caries in the adult and elderly population can also be regarded as high in this region. The risk/protective factors (e.g., sugar consumption, exposure to fluoride, and oral hygiene) probably operate similarly in all LACCs, although variations in the interplay of these factors in some countries and within the same country cannot be ruled out. Although salt and water fluoridation programs are implemented in many countries, there is a need for implementation of a surveillance policy. There is also room for improvement with regard to the introduction of minimal intervention techniques in practice and public health programs. Dental caries is a marker of social disadvantage, and oral health promotion programs and interventions aimed at reducing the burden of dental caries in LACCs must consider the complexity of the socioeconomic dynamics in this region. There is an urgent need to promote engagement of stakeholders, policymakers, medical personnel, universities, dental associations, community members, and industries to develop regional plans that enhance the oral health agenda for LACCs. A list of recommendations has been presented to underpin strategies aimed at reducing the prevalence and severity of dental caries and improving the quality of life of the impacted LACC population in the near future.

摘要 龋病（dental caries）可得到有效管控，并可在保留各层级牙齿结构的前提下，阻止其发展为龋洞病变。然而，龋病与社会经济因素间的强相关性，可能削弱预防策略的实施效果。拉丁美洲及加勒比国家（Latin American and Caribbean countries, LACC）中龋病相关不平等问题持续高发，这一现象令人担忧。该区域部分国家的龋病疾病负担评估数据已过时，甚至缺失。

本文旨在总结并呈现针对LACC龋病流行现状、发展前景与挑战的区域专家共识最终建议。本次共识基于由拉丁美洲专家团队撰写、牙科协会审核，并在两场共识研讨会上展示与讨论的四篇学术文章。本次共识探讨了四大研究领域：流行病学、危险因素、预防策略，以及以修复操作为重点的龋病管理方案。

龋病可贯穿个体生命周期全程，因此对婴幼儿、儿童、成年人及老年群体均构成健康威胁。全球诸多地区——包括LACC——的乳牙与恒牙未治疗龋病患病率均居高不下。既往研究证据显示，多数拉丁美洲国家12岁儿童的龋病患病率处于中高水平。此外，该区域成人与老年群体的龋病患病率及治疗需求率同样处于较高水平。

尽管糖摄入、氟暴露、口腔卫生等风险/保护因素在LACC中的作用机制或具有共性，但部分国家乃至同一国家内部这些因素的交互作用存在差异，这一点不容忽视。尽管诸多国家已推行食盐及饮水氟化项目，但仍需建立健全公共卫生监测体系。同时，在临床实践与公共卫生项目中推广微创干预技术仍有较大提升空间。

龋病是社会弱势地位的标志性健康指标，因此针对LACC开展的口腔健康促进项目及旨在减轻龋病疾病负担的干预措施，必须充分考量该区域社会经济动态的复杂性。当前亟需推动利益相关方、政策制定者、医护人员、高校、牙科协会、社区成员及产业界的广泛协作，制定区域规划以推进LACC的口腔健康议程。本次共识已提出一系列建议，旨在为未来降低LACC人群龋病患病率与严重程度、改善受影响群体生活质量的相关策略提供理论支撑。