Skip to main content
Download PDF

Global, regional, and national caries of permanent teeth incidence, prevalence, and disability-adjusted life years, 1990-2021: analysis for the global burden of disease study

BMC Oral Health volume 25, Article number: 715 (2025) Cite this article

Abstract

Objectives

This study aims to analyze the global, regional, and national incidence, prevalence, and disability-adjusted life years (DALYs) related to caries of permanent teeth from 1990 to 2021, as part of the Global Burden of Disease Study (GBD).

Study design and methods

Data on incidence, prevalence, and DALYs were extracted and analyzed for various demographic and regional categories. Age-standardized incidence rates (ASIR), age-standardized prevalence rates (ASPR), and age-standardized DALY rates (ASDAR) were calculated. Temporal trends and associations with sociodemographic index (SDI) were also examined.

Results

In 2021, there were approximately 2.37 billion cases of caries of permanent teeth, with an ASIR of 29,777.03 per 100,000 population. The prevalence was around 2.24 billion, with an ASPR of 27,543.34 per 100,000. Females exhibited a higher disease burden than males, and the burden increased with age, peaking in the 20–24 age group. Regions with lower SDI showed higher ASIRs, while the highest burden was noted in Tropical Latin America. Significant increases in disease burden were observed from 1990 to 2021, particularly in China and Colombia, while Japan showed a decrease. The Bayesian age-period-cohort (BAPC) predictions indicate that the burden of caries of permanent teeth will continue to increase year by year.

Conclusion

The burden of caries of permanent teeth varies significantly across regions and demographics, with higher rates in lower SDI areas. The findings underscore the importance of targeted interventions and resource allocation in high-burden regions to improve dental health outcomes.

Peer Review reports

Introduction

Caries of permanent teeth, a highly prevalent chronic disease, poses a substantial burden on global health and well-being. Understanding its temporal trends, geographical variations, and disease burden in terms of incidence, prevalence, and disability-adjusted life years (DALYs) is critical for informing public health policies and interventions aimed at mitigating its impact. Previous research, such as the Global Burden of Oral Diseases studies, has underscored the significant contribution of dental caries to the overall oral health burden worldwide [1, 2]. However, a comprehensive and updated analysis encompassing recent data spanning three decades is lacking, which limits our understanding of the evolving caries landscape and hinders the development of effective strategies to address this pressing health issue.

Existing studies often lack detailed temporal trend analyses, geographical comparisons at fine resolutions, and in-depth explorations of the drivers behind observed patterns. Furthermore, oral diseases, including dental caries, have been increasingly recognized as integral to overall health and well-being, with links to various systemic conditions such as cardiovascular disease, diabetes, and respiratory illnesses [3, 4]. Therefore, addressing the burden of caries of permanent teeth is not merely an oral health concern but a crucial aspect of promoting overall population health.

Notably, the distribution of caries burden is heterogeneous, with notable disparities across geographical regions and socioeconomic strata. Low- and middle-income countries often bear a disproportionately higher burden due to limited access to oral healthcare services, poor oral hygiene practices, and unhealthy diets [5, 6]. This study aims to delve deeper into these issues, highlighting these disparities and their implications for global health equity.

To fill this knowledge gap, we leverage the rigorous methodology and extensive data sources of the Global Burden of Disease (GBD) framework. By utilizing GBD estimates, this study seeks to: (1) quantify the incidence, prevalence, and DALYs of caries of permanent teeth globally, regionally, and nationally; (2) analyze temporal trends in these metrics over the past three decades; and (3) identify key drivers of the observed patterns and variations, specifically focusing on sex, age, socioeconomic factors, and geographic location. By addressing these specific deficiencies in the existing research, this study aims to contribute significantly to our understanding of dental caries and its impact on global health.

Building on this rationale, the present study aimed to analyze the global, regional, and national trends in the incidence, prevalence, and DALYs of caries of permanent teeth from 1990 to 2021, utilizing the comprehensive data and methodology of the GBD 2021 study. By identifying key trends and drivers, we hope to inform more targeted and effective strategies to reduce the burden of dental caries globally, thereby promoting overall population health and equity.

Methods

This retrospective study analyzed the burden of caries of permanent teeth across 204 countries and territories from 1990 to 2021. Below, we detail the data sources, estimation frameworks, and statistical approaches used to address the study’s objectives.

Data sources and estimation methods

Data for this study were sourced from the GBD 2021 database, which integrates diverse datasets including cancer registries, population surveys, published literature, and surveillance systems. The GBD 2021 framework harmonizes these data through a multi-step process:

  1. 1.

    Data Harmonization: Definitions, classifications, and measurement units were aligned across sources to ensure consistency in health outcome reporting. Disease categories were mapped to a common taxonomy, minimizing discrepancies in case definitions.

  2. 2.

    Population Standardization: Age-standardized rates were applied to account for demographic variations, enabling equitable comparisons across populations.

  3. 3.

    Geographical and Temporal Adjustment: Data were aggregated to common geographical resolutions (e.g., national levels) and adjusted for temporal trends to reduce confounding from regional or period-specific biases.

To address missing data, the GBD 2021 employed:

  1. 1.

    Imputation Techniques: Multiple imputation and regression-based methods estimated missing values using covariate patterns and temporal trends.

  2. 2.

    Data Extrapolation: Subnational gaps were filled using hierarchical models that borrowed strength from analogous regions or higher aggregation levels.

The GBD employs a systematic and standardized approach to estimate health outcomes, including the use of DisMod-MR 2.1, a Bayesian meta-regression tool, to ensure consistency and comparability across locations and time [7].

To address data limitations, particularly the reliance on secondary sources and the lack of granular geographic information for large countries like China, DisMod-MR 2.1 incorporates a series of methods to handle data sparsity and uncertainty. These include the use of hierarchical models, which borrow strength across related geographical units or time points, and the application of smoothing techniques to produce plausible estimates even in areas with limited data [8]. However, it is acknowledged that these methods may introduce some biases, and the resulting estimates should be interpreted with caution, particularly in regions where data scarcity is a concern.

The GBD 2021 database provided data for 204 countries and territories. For geographical analysis, the 204 countries and territories were segmented into 54 GBD regions. Moreover, these same countries were categorized by socioeconomic development status into five Sociodemographic Index (SDI) levels: low, low-middle, middle, high-middle, and high. The methodological framework of the GBD 2021 has been described in prior studies [9, 10]. All data, along with their respective 95% uncertainty intervals (UIs), were derived from various sources, including cancer registries, published studies, surveillance data, census data, and other relevant sources [11]. The estimates were tailored to specific locations, sexes, and age groups. The DALYs were calculated by aggregating the Years lived with disability (YLDs) and Years of Life Lost (YLLs) for each respective cause [12].

For regions lacking longitudinal data, incidence rates were estimated via:

  1. 1.

    Cross-Sectional Studies: Prevalence data were converted to incidence estimates using disease duration and mortality rates.

  2. 2.

    Expert Elicitation: Field experts provided contextual insights for underdocumented outcomes.

  3. 3.

    Spatial–Temporal Modeling: Bayesian frameworks integrated sparse data with covariates (such as socioeconomic indicators) to generate plausible estimates.

Statistical analyses

The statistical analyses conducted in this study were comprehensive and rigorous. First, in 2021, incidence, prevalence, and DALYs of caries of permanent teeth, along with corresponding Age-Standardized Rates (ASRs), were assessed globally and by subtypes such as age, sex, SDI regions, GBD regions, and countries. Second, a thorough analysis was carried out to investigate the temporal trends of this disease burden globally and by subtype from 1990 to 2021. A linear regression model was used to calculate the estimated annual percentage change (EAPC).

In addition, the relationship between EAPCs, caries of permanent teeth-related ASRs in 1990, and Human Development Index (HDI) in 2021 was assessed. Because these three factors were not normally distributed, the Spearman correlation analysis was used to investigate their associations. Furthermore, a hierarchical cluster analysis was carried out, using the EAPC values, to analyze the changing patterns of disease burden across various GBD regions and find those with comparable tendencies. As a result, all 54 GBD locations were divided into four unique categories: substantial rise, slight increase, steady or small drop, and significant decrease.

Moreover, we used the Bayesian Age-Period-Cohort (BAPC) model, together with nested Laplace approximations, to forecast the future illness burden from 2022 to 2046. The BAPC model was chosen for our forecasting analysis due to its ability to account for complex dependencies between age, period, and cohort effects, which are often present in epidemiological data. This model allows for the simultaneous estimation of these effects, providing a more nuanced understanding of trends and patterns over time. Additionally, the Bayesian framework enables the incorporation of prior information and the quantification of uncertainty in our estimates, which is crucial for making informed decisions in public health policy and practice.

Decomposition analyses were used to look deeper into the mechanisms driving changes in the illness burden between 1990 and 2021, with an emphasis on age structure, population size, and epidemiological alterations. Finally, frontier analysis was used to determine the relationship between disease burden and socioeconomic development. By developing a nonlinear frontier, we were able to determine the lowest possible burden based on a country's or region's current development state. Non-parametric data envelope analysis was used to facilitate this research, with earlier studies providing methodological direction. The effective difference, which represents the gap between the observed DALY rate and the frontier, represents the potential health improvements that could be realized at the current level of development.

Statistical significance was determined at a P-value of less than 0.05. We used R software (version 4.0.2) to generate, collate, and analyze the database.

Results

The disease burden attributable to caries of permanent teeth in 2021

The disease burden attributable to caries of permanent teeth in 2021 is significant. Specifically, the number of incidence cases reached 2,370,414,032, with a range of 2,099,098,156 to 2,661,346,388, corresponding to an age-standardized incidence rate (ASIR) of 29,777.03 per 100,000 population, ranging from 26,310.27 to 33,490.91. Similarly, the number of prevalence cases amounted to 2,242,874,758, ranging from 1,957,579,677 to 2,599,622,169, with an age-standardized prevalence rate (ASPR) of 27,543.34 per 100,000 population, varying between 23,976 and 32,018.09. Additionally, the number of DALYs cases was 2,198,064, with a range of 988,183 to 4,174,725, corresponding to an age-standardized DALY rate (ASDAR) of 27.02 per 100,000 population, ranging from 12.1 to 51.36 (Tables 1, 2 and 3).

Table 1 The number of incidence cases and the age-standardized incidence rate attributable to caries of permanent teeth in 1990 and 2021 and its trends from 1990 to 2021 globally
Full size table
Table 2 The number of prevalence cases and the age-standardized prevalence rate attributable to caries of permanent teeth in 1990 and 2021 and its trends from 1990 to 2021 globally
Full size table
Table 3 The number of DALYs cases and the age-standardized DALYs rate attributable to caries of permanent teeth in 1990 and 2021 and its trends from 1990 to 2021 globally
Full size table

Gender differences in the disease burden were observed, with females experiencing slightly higher prevalence and DALYs than males, although incidence rates were comparable between sexes (Figure S1, Tables 1, 2 and 3).

Figure 2 depicts the incidence, prevalence, and DALYs for each age group in 2021. The disease burden initially rises with age, peaking in the 20–24 age range, before declining (Figure S2, Tables 1, 2 and 3).

At the SDI region level, the low-middle SDI region exhibited the highest ASIR at 31,182.47, with a range of 27,260.31 to 35,209.32, whereas the high-middle SDI regions had the lowest ASIRs at 28,068.89, ranging from 24,352.04 to 31,973.91. Notably, ASPR and ASDAR values decreased with increasing SDI region levels, indicating a higher disease burden in less developed regions (Figure S3, Tables 1, 2 and 3). Intriguingly, the age-standardized rates for incidence, prevalence, and DALYs displayed a"W-shaped"relationship with SDI, with peak rates observed when the SDI was approximately 0.75, as depicted in Fig. 1.

Fig. 1
figure 1

Age-standardized rates of incidence, prevalence, and DALYs attributable to caries of permanent teeth across countries and territories by socio-demographic index for both sexes, 1990–2019. The black line was an adaptive association fitted with adaptive Loess regression based on all data points. Abbreviations: DALYs, disability-adjusted-life-years

Full size image

Regionally, Tropical Latin America had the highest caries of permanent teeth-related ASIR, while East Asia had the lowest, across the 54 GBD regions. Andean Latin America ranked highest in ASPR and ASDAR, with High-income Asia Pacific ranking lowest for prevalence and DALYs (Figure S4, Tables 1, 2 and 3).

At the country level, Cambodia had the highest ASIR, Madagascar had the highest ASPR, and Serbia had the highest ASDAR per 100,000 population in 2021. In contrast, Taiwan (Province of China) had the lowest ASIR, Japan had the lowest ASPR and ASDAR. India reported the highest absolute number of incidence, prevalence, and DALYs cases, while Tokelau had the lowest. These findings highlight the substantial global variation in the disease burden of caries of permanent teeth (Fig. 2, Figure S5, Tables 1, 2 and 3).

Fig. 2
figure 2

Age-standardized rates of caries of permanent teeth-related incidence, prevalence, and DALYs across countries and territories in 2021. Abbreviations: DALYs, disability-adjusted life years

Full size image

Temporal trend for caries of permanent teeth-related disease burden from 1990 to 2021

The number of incidence cases of caries in permanent teeth globally increased from 1990 to 2021, despite a slight decline in the ASIR during the same period. However, the prevalence and DALYs estimates exhibited a contrasting pattern: while cases increased, both the ASPR and ASDAR declined (Fig. 3, Tables 1, 2 and 3).

Fig. 3
figure 3

Trends in the numbers and age-standardized rates of caries of permanent teeth-related incidence, prevalence, and DALYs globally from 1990 to 2021. Abbreviations: DALYs, disability-adjusted-life-years

Full size image

When examining trends by gender, we found that they mirrored those observed in the overall population consistently (Figure S6, Tables 1, 2 and 3). Similarly, trends across most age groups were also consistent, aligning with the overall population trends (Figure S7, Tables 1, 2 and 3). At the SDI region level, the ASIR increased in low and low-middle SDI regions, whereas it decreased in other SDI regions. In contrast, for ASPR and ASDAR, the middle SDI region demonstrated an upward trend, while other regions showed a declining trend (Figure S8, Tables 1, 2 and 3).

The disease burden associated with caries in permanent teeth varied significantly across GBD regions. In this study, we employed a hierarchical clustering approach to identify locations with similar illness load variations. The results revealed significant increases in ASRs in several regions, including Eastern Africa, Central Europe, and Southeast Asia. Conversely, significant decreases were observed in East Asia and the Western Pacific Region (Figure S9).

When analyzing trends across countries and territories, we noted notable differences. China experienced the most pronounced increase in ASIR from 1990 to 2021, with an EAPC of 1.3 (95% confidence interval: 1.02–1.58). In contrast, Colombia showed the most significant increase in ASPR and ASDAR, with EAPCs of 0.83 (95% CI: 0.46–1.2) and 0.83 (95% CI: 0.47–1.2), respectively. Conversely, Japan exhibited the most notable decrease in ASPR and ASDAR, with an EAPC of −0.53 (95% CI: −0.64 to −0.43). Similarly, Morocco also showed a substantial decline in both ASPR and ASDAR, with EAPCs of −1.17 (95% CI: −1.51 to −0.83) and −1.17 (95% CI: −1.5 to −0.83), respectively (Figure S10, Tables 1, 2 and 3).

The influential factors for EAPC

Our analysis revealed that the EAPCs for caries of permanent teeth are associated with both the ASRs in 1990 and the HDIs in 2021. Specifically, the ASRs in 1990 reflected the existing disease pool at that time, serving as a baseline for comparison. In contrast, the HDIs in 2021 served as indicators of healthcare access and quality across different countries. Notably, we observed a strong correlation between EAPCs and both the ASRs of prevalence and DALYs, suggesting that improvements in oral healthcare and prevention measures have positively contributed to reducing the severity of dental caries. However, no significant relationship was found between EAPCs and HDIs, hinting that factors beyond healthcare may also influence disease trends (Fig. 4).

Fig. 4
figure 4

The association between EAPCs and caries of permanent teeth-related ASRs in 1990 and HDIs in 2021. The circles represent countries that were available on HDI data. The size of the circle is increased with the cases of caries of permanent teeth. The ρ indices and p values presented were derived from Spearman correlation analysis. Abbreviations: EAPC, estimated annual percentage change; ASR, age-standardized rate; HDI, human development index

Full size image

The predicted results from 2022 to 2046

The predictive outcomes from the BAPC model indicate an increase in the number of incidence cases, prevalence cases, and DALYs for both sexes from 2022 to 2046 (Figure S11 and S12, Table 4). These statistical trends highlight a concerning upward trajectory in the global burden of dental caries. However, it is crucial to interpret these trends within the context of broader systemic factors and public health interventions, as they provide a comprehensive view of the oral health landscape.

Table 4 The predicted results in the caries of permanent teeth-related numbers and age-standardized rates of incidence prevalence and DALYs by sex globally from 2022 to 2046 of the BAPC model
Full size table

Frontier analysis for ASRs of caries of permanent teeth

Figure 5 presents the unrealized health advancements in the ASRs of caries of permanent teeth, stratified by sociodemographic development levels across various countries and regions from 1990 to 2021. Our analysis uncovered distinct patterns and disparities in the effectiveness of oral health interventions across these strata. Notably, as sociodemographic development progresses, the disparities in caries burden generally widen, indicating a greater potential for improvement among higher SDI nations or regions in 2021. This finding underscores the complex interplay between societal advancement and oral health outcomes, emphasizing the need for targeted interventions tailored to the unique challenges faced by each developmental tier.

Fig. 5
figure 5

Frontier analysis based on SDI and ASRs of the caries of permanent teeth in 2021. The frontier is delineated in solid black color; countries and territories are represented as dots. The top 15 countries with the largest effective difference (largest ASRs gap from the frontier) are labeled in black; examples of frontier countries with low SDI (< 0.5) and low effective difference are labeled in blue, and examples of countries and territories with high SDI (> 0.85) and relatively high effective difference for their level of development are labeled in red. Red dots indicate an increase in age-standardized ASRs from 1990 to 2021; blue dots indicate a decrease in ASRs between 1990 and 2021. Abbreviations: ASRs: Age-Standardized Rates; SDI: Socio-demographic index

Full size image

Discussion

As far as we know, this was the first study to systematically examine and quantify the global disease burden of caries in permanent teeth. In 2021, it generated a substantial global burden, with considerable disparities across sexes, ages, SDI regions, GBD regions, and countries. Despite global improvements between 1990 and 2021, our forecasted results indicated that the disease burden would rise over the next 25 years. Notably, countries or regions with higher SDIs have greater potential for further improvement in reducing this burden.

Our findings are consistent with previous studies that have documented the global burden of dental caries and emphasized the need for continued efforts to address this prevalent oral health issue [13, 14]. The observed variations in ASIR, ASPR, and ASR of DALYs highlight the complexity of dental caries epidemiology and underscore the importance of considering multiple metrics when assessing disease burden. Future research endeavors should focus on identifying the underlying factors driving these trends, including socioeconomic status [15], access to oral healthcare [16], and lifestyle habits [17]. Specifically, studies could explore innovative approaches such as the use of teledentistry to improve access to care in underserved areas [18], or the development of new materials and technologies for preventive and restorative treatments [19]. Additionally, future research should evaluate the efficacy of current prevention and treatment strategies, such as fluoride varnishes [20], sealants [21], and community-based oral health programs [5]. By investigating these and other potential areas, researchers can further diminish the burden of caries affecting permanent teeth globally.

The observation that the disease burden of the studied condition in 2021 was predominantly higher in females than males, with the exception of incidence cases where the sex gap was minimal, is intriguing and warrants further exploration. This sex disparity in disease burden aligns with previous research that has emphasized the influence of biological, social, and behavioral factors on health outcomes, particularly in the context of chronic and non-communicable diseases [22, 23]. The consistency in trends between males and females, when analyzed separately, mirroring those of the overall population, underscores the uniformity of the disease's epidemiology across sexes. However, the subtle yet significant difference in burden allocation suggests potential sex-specific factors contributing to these disparities. To address these disparities, actionable implications must be considered. For instance, tailored interventions aimed at modifying healthcare-seeking behaviors, improving access to care, and addressing sociocultural norms related to health and illness may be crucial [24]. Furthermore, the negligible sex gap in incidence cases indicates comparable exposure to risk factors between males and females. Yet, the disparity in disease burden, particularly in terms of prevalence and severity, underscores the need for sex-sensitive approaches in disease prevention, diagnosis, and management strategies. By acknowledging and addressing these sex-specific factors, we can strive to achieve more equitable health outcomes for both males and females.

The pattern of disease burden across age groups in 2021 reveals an intriguing trend. The initial increase in incidence, prevalence, and DALYs with age, peaking in the 20–24 age group, followed by a subsequent decline, presents a nuanced view that deserves further attention. While this finding contrasts with many existing studies that typically report a steady rise in disease burden with advancing age, particularly for non-communicable diseases [25], it is important to note that the peak in the 20–24 age group may reflect unique vulnerabilities within this demographic. Factors such as lifestyle choices, exposure to new risk factors, or a combination of biological and social transitions could contribute to this peak. Given this unique trend, it is crucial to consider potential interventions tailored to the needs of the 20–24 age group. Existing evidence suggests that interventions focused on promoting healthy lifestyles, such as regular physical activity, balanced nutrition, and avoiding harmful behaviors (like smoking, excessive alcohol consumption), could be beneficial in reducing disease burden in this population [26]. Additionally, targeted health promotion programs that address the specific risk factors and vulnerabilities of this age group may further enhance their effectiveness. For instance, programs that provide education on mental health, sexual health, and substance abuse prevention could be particularly relevant. While this observation challenges the conventional assumption of a monotonic relationship between age and disease burden, it aligns with emerging research that highlights the complexity of disease burden dynamics across different age groups [27]. The consistency of trends across most age groups further strengthens our understanding of the disease's epidemiology. However, the deviation from the expected trend in the 20–24 age group underscores the importance of nuanced age-specific analysis and highlights the need for targeted interventions and health promotion programs aimed at this vulnerable population.

The disease burden across different SDI regions offers valuable insights into the intricate interplay between socioeconomic development and disease burden. Consistent with prior studies [28, 29], our findings reveal that the lowest-SDI regions face the highest ASIR, potentially due to inadequate healthcare infrastructure, limited access to preventive services, and higher exposure to risk factors. Conversely, the decline in ASIRs observed in high-middle SDI regions may be attributed to better healthcare systems, higher levels of awareness, and improved living conditions. The inverse correlation between ASPR, ASDAR, and SDI levels suggests that as countries progress socioeconomically, they become better equipped to manage the disease, resulting in lower rates of prevalence and DALYs. However, our analysis also uncovers a complex'w-shaped relationship'between ASRs and SDI, with a notable peak around an SDI of 0.75. This finding challenges the simplistic narrative that socioeconomic advancement inevitably leads to reduced disease burden. Instead, it underscores the importance of a nuanced understanding of the transition phases, where middle-SDI regions may experience a surge in disease burden due to rapid urbanization, lifestyle changes, and emerging risk factors. Given this consistent pattern, where disease burden first increases and then decreases with SDI, peaking in middle-SDI regions, it is crucial to implement tailored interventions specifically targeting these critical developmental stages. For middle-SDI regions undergoing rapid urbanization, strategies such as public–private oral health partnerships could be particularly effective in addressing the surge in disease burden. These partnerships can leverage the resources and expertise of both the public and private sectors to enhance access to oral health care services, improve preventive measures, and raise awareness about risk factors. While all SDI regions exhibited an upward trend in the number of cases, indicating an overall increase in global disease burden, the varying trends in ASRs across different SDI regions highlight the importance of context-specific strategies to effectively address this issue. By considering the unique challenges and opportunities presented by different SDI regions, we can develop more targeted and effective interventions to reduce disease burden globally.

The findings underscore the disproportionate distribution of this disease, highlighting the need for targeted interventions in high-burden regions. The observed disparities in caries burden align with previous studies that have emphasized the role of socioeconomic factors, oral hygiene practices, and access to dental care in shaping disease patterns [4]. For instance, the high burden in Tropical and Andean Latin America could be attributed to limited access to preventive services, inadequate oral health education, and barriers to care related to poverty, such as financial constraints, lack of transportation, and unavailability of dental services in rural or underserved areas [30]. Conversely, the relatively low burden in East Asia, particularly in countries like Japan and Taiwan, could be linked to robust public health systems, widespread use of fluoride, and cultural norms favoring oral hygiene [31]. Our analysis further reveals that within countries, the burden of caries has evolved dynamically over time. The notable increase in ASIR in China, for example, underscores the need for continued efforts to improve oral health education and access to dental services, despite recent improvements in overall health indicators [32]. Similarly, the substantial decrease in caries burden in Japan and Morocco highlights the effectiveness of targeted interventions, such as school-based oral health programs and fluoridation policies, in reducing disease prevalence [33, 34]. The hierarchical clustering analysis conducted in this study provides valuable insights into the spatial patterns of caries burden, identifying regions with similar trends in disease burden. This information can inform the development of region-specific strategies for caries prevention and control, leveraging shared challenges and opportunities across neighboring countries. For instance, the observed increase in ASRs across multiple regions, including Eastern Africa and Southeast Asia, suggests a need for intensified efforts to improve oral health infrastructure and access to care in these areas. Moreover, our findings emphasize the importance of considering both incidence and prevalence when assessing the burden of caries. While high incidence rates indicate a need for preventive measures, high prevalence rates underscore the urgency of implementing restorative and rehabilitative services to mitigate the long-term consequences of untreated caries. The substantial number of DALYs attributed to caries in India, for instance, underscores the significant impact of this disease on individual well-being and societal productivity, necessitating a multi-faceted approach to address both prevention and treatment needs.

The observed associations between EAPCs and ASRs in 1990 emphasize the intricate interplay between disease burden and its subsequent trends. Our findings align with previous studies that have emphasized the baseline disease burden as a crucial determinant of future health trajectories [35, 36]. Notably, the positive correlation between EAPCs and ASRs suggests that countries with higher initial caries burdens experienced more pronounced improvements or deteriorations over time, potentially due to variations in health policies, interventions, and resource allocations. While socioeconomic development, as indicated by HDIs, is often considered a key factor in health outcomes, our analysis in 2021 revealed no significant association between EAPCs and HDIs. This divergence challenges the notion that economic progress automatically translates into improved oral health outcomes and underscores the need to consider a broader range of factors. In this context, the importance of targeted interventions and equitable access to oral healthcare services becomes even more evident [37, 38]. Moreover, our results highlight the potential role of other determinants, such as cultural practices, dietary habits, and oral health literacy, in shaping caries trends [39, 40]. The discrepancy between the significant associations with ASRs and the non-significant link to HDIs further underscores the complexity of oral health determinants and emphasizes the need for multi-faceted strategies to address the global burden of caries. In light of these findings, future research should delve deeper into the contextual factors modulating these relationships, including but not limited to the impact of COVID-19 on oral health services, changing lifestyles, and the effectiveness of public health interventions [41, 42]. We believe that a comprehensive understanding of these factors will be crucial in developing effective strategies to improve oral health worldwide.

The projected trends from our BAPC model, predicting a steady rise in incidence, prevalence, and DALYs for both sexes over the next two decades (2022–2046), underscore the pressing need for urgent and sustained interventions. These findings amplify the growing concern voiced in recent literature about the ongoing challenge posed by non-communicable diseases (NCDs) globally [43, 44]. Our projections exceed the anticipated burdens reported in previous studies, highlighting the need for re-evaluation of current strategies and intensification of preventive measures [45, 46]. Demographic shifts, including population aging and lifestyle changes, may exacerbate these trends, necessitating a holistic approach. This approach should address not only clinical management but also behavioral modifications and public health policies aimed at mitigating risk factors [47, 48]. Ultimately, these predictions emphasize the importance of ongoing surveillance, timely adaptation of healthcare systems, and increased investment in research to identify innovative solutions for managing and potentially reversing these distressing trends.

Figure 5 illuminates a complex narrative of unrealized health advancements in ASRs of caries in permanent teeth, stratified by sociodemographic development levels. Our findings resonate with yet challenge the conventional wisdom that societal progress inherently leads to improved oral health. Instead, they underscore a paradox: as sociodemographic indices rise, the gap in caries burden efficacy widens, suggesting that disparities increase with development. This divergence mirrors similar trends reported in global health literature [5, 49], where advancements in certain health metrics do not uniformly translate across socioeconomic strata. Our results emphasize the need for nuanced, tiered approaches to oral health interventions, recognizing that the challenges and opportunities for improvement vary substantially based on a country's or region's developmental status. Such insights underscore the importance of contextualized policies and strategies, tailored to address the specific barriers and facilitators of oral health within each sociodemographic stratum [30].

This study, reliant on the GBD database, encounters limitations primarily stemming from data. The absence of detailed county/province-level data, exemplified by China's vast territory, restricts in-depth analyses [50]. Furthermore, the reliance on secondary data estimated by DisMod-MR introduces uncertainty, particularly in data-scarce countries where estimates may be borrowed from others [51]. To address these limitations in future iterations of the GBD study, we suggest incorporating more primary data sources to enhance the accuracy and robustness of findings. This would involve investing in data collection efforts at more granular geographical levels and improving the methodologies for estimating missing data, particularly in regions with limited data availability.

Conclusion

In conclusion, caries of permanent teeth posed a significant disease burden over the world, particularly in low-income countries. Furthermore, our findings indicated that young adults were at greater risk. We also discovered that the disease burden will continue to rise over the next 25 years, indicating that caries in permanent teeth remained a significant public health issue that needed to be addressed. Countries or areas with a higher SDI have more room to improve their burdens. Stricter mitigation and adaption techniques should be applied and developed to safeguard persons and control caries in permanent teeth.

Data availability

Data for this study were sourced from the GBD 2021 database. The GBD employs a systematic and standardized approach to estimate health outcomes, including the use of DisMod-MR 2.1, a Bayesian meta-regression tool, to ensure consistency and comparability across locations and time.

Data is provided within the manuscript or supplementary information files.

References

  1. He H, Xie H, Chen Y, Li C, Han D, Xu F, Lyu J. Global regional and national burdens of bladder cancer in 2017: estimates from the 2017 global burden of disease study. BMC Public Health. 2020;20(1):1693.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bu X, Xie Z, Liu J, Wei L, Wang X, Chen M, Ren H. Global PM2.5-attributable health burden from 1990 to 2017: estimates from the Global Burden of disease study 2017. Environ Res. 2021;197:111123.

    Article  PubMed  CAS  Google Scholar 

  3. Kassebaum NJ, Bernabé E, Dahiya M, Bhandari B, Murray CJ, Marcenes W. Global burden of severe tooth loss: a systematic review and meta-analysis. J Dent Res. 2014;93(7 Suppl):20s–8s.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  4. Marcenes W, Kassebaum NJ, Bernabé E, Flaxman A, Naghavi M, Lopez A, Murray CJ. Global burden of oral conditions in 1990–2010: a systematic analysis. J Dent Res. 2013;92(7):592–7.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  5. Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The global burden of oral diseases and risks to oral health. Bull World Health Organ. 2005;83(9):661–9.

    PubMed  PubMed Central  Google Scholar 

  6. Peres MA, Macpherson LMD, Weyant RJ, Daly B, Venturelli R, Mathur MR, Listl S, Celeste RK, Guarnizo-Herreño CC, Kearns C, et al. Oral diseases: a global public health challenge. Lancet. 2019;394(10194):249–60.

    Article  PubMed  Google Scholar 

  7. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2163–96.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Peterson HM, Flaxman AD. Meta-regression with DisMod-MR: how robust is the model? Lancet. 2013;381:S110.

    Article  Google Scholar 

  9. Collaborators GD. Global regional and national burden of diabetes from 1990 to 2021 with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2023;402(10397):203–34.

    Article  Google Scholar 

  10. Collaborators GLBP. Global regional and national burden of low back pain 1990–2020 its attributable risk factors and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023;5(6):e316–29.

    Article  Google Scholar 

  11. Collaborators GDaIIaP. Global regional and national incidence prevalence and years lived with disability for 354 diseases and injuries for 195 countries and territories 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789–858.

    Article  Google Scholar 

  12. Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2197–223.

    Article  PubMed  Google Scholar 

  13. Wen PYF, Chen MX, Zhong YJ, Dong QQ, Wong HM. Global burden and inequality of dental caries 1990 to 2019. J Dent Res. 2022;101(4):392–9.

    Article  PubMed  CAS  Google Scholar 

  14. Petersen PE. The World Oral Health Report 2003: continuous improvement of oral health in the 21st century–the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol. 2003;31(Suppl 1):3–23.

    Article  PubMed  Google Scholar 

  15. Kassebaum NJ, Bernabé E, Dahiya M, Bhandari B, Murray CJ, Marcenes W. Global burden of untreated caries: a systematic review and metaregression. J Dent Res. 2015;94(5):650–8.

    Article  PubMed  CAS  Google Scholar 

  16. Watt RG, Daly B, Allison P, Macpherson LMD, Venturelli R, Listl S, Weyant RJ, Mathur MR, Guarnizo-Herreño CC, Celeste RK, Peres MA, Kearns C, Benzian H. Ending the neglect of global oral health: time for radical action. Lancet. 2019;394(10194):261–72.

    Article  PubMed  Google Scholar 

  17. Moynihan PJ, Kelly SA. Effect on caries of restricting sugars intake: systematic review to inform WHO guidelines. J Dent Res. 2014;93(1):8–18.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  18. Mariño R, Ghanim A. Teledentistry: a systematic review of the literature. J Telemed Telecare. 2013;19(4):179–83.

    Article  PubMed  Google Scholar 

  19. Vaderhobli RM. Advances in dental materials. Dent Clin North Am. 2011;55(3):619–25 x.

    Article  PubMed  Google Scholar 

  20. Marinho VC, Worthington HV, Walsh T, Clarkson JE. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2013;2013(7):CD002279.

    PubMed  PubMed Central  Google Scholar 

  21. Ahovuo-Saloranta A, Forss H, Walsh T, Nordblad A, Mäkelä M, Worthington HV. Pit and fissure sealants for preventing dental decay in permanent teeth. Cochrane Database Syst Rev. 2017;7(7):CD001830.

    PubMed  Google Scholar 

  22. Shannon G, Jansen M, Williams K, Cáceres C, Motta A, Odhiambo A, Eleveld A, Mannell J. Gender equality in science medicine and global health: where are we at and why does it matter? Lancet. 2019;393(10171):560–9.

    Article  PubMed  Google Scholar 

  23. Seeman MV. Gender differences in the prescribing of antipsychotic drugs. Am J Psychiatry. 2004;161(8):1324–33.

    Article  PubMed  Google Scholar 

  24. Amin L, Shah BR, Bierman AS, Lipscombe LL, Wu CF, Feig DS, Booth GL. Gender differences in the impact of poverty on health: disparities in risk of diabetes-related amputation. Diabet Med. 2014;31(11):1410–7.

    Article  PubMed  CAS  Google Scholar 

  25. Xi JY, Zhang YX, Lin X, Hao YT. Burden of non-communicable diseases attributable to population aging in China 1990–2050. Zhonghua Yu Fang Yi Xue Za Zhi. 2023;57(5):667–73.

    PubMed  CAS  Google Scholar 

  26. Hargreaves D, Mates E, Menon P, Alderman H, Devakumar D, Fawzi W, Greenfield G, Hammoudeh W, He S, Lahiri A, et al. Strategies and interventions for healthy adolescent growth nutrition and development. Lancet. 2022;399(10320):198–210.

    Article  PubMed  Google Scholar 

  27. Lopez AD, Murray CCJL. The global burden of disease 1990–2020. Nat Med. 1998;4(11):1241–3.

    Article  PubMed  CAS  Google Scholar 

  28. Collaborators GS. Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1423–59.

    Article  Google Scholar 

  29. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors 2001: systematic analysis of population health data. Lancet. 2006;367(9524):1747–57.

    Article  PubMed  Google Scholar 

  30. Sheiham A, Watt RG. The common risk factor approach: a rational basis for promoting oral health. Community Dent Oral Epidemiol. 2000;28(6):399–406.

    Article  PubMed  CAS  Google Scholar 

  31. Murakami K, Aida J, Kuriyama S, Hashimoto H. Associations of health literacy with dental care use and oral health status in Japan. BMC Public Health. 2023;23(1):1074.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Zhou X, Xu X, Li J, Hu D, Hu T, Yin W, Fan Y, Zhang X. Oral health in China: from vision to action. Int J Oral Sci. 2018;10(1):1.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Haque SE, Rahman M, Itsuko K, Mutahara M, Kayako S, Tsutsumi A, Islam MJ, Mostofa MG. Effect of a school-based oral health education in preventing untreated dental caries and increasing knowledge attitude and practices among adolescents in Bangladesh. BMC Oral Health. 2016;16:44.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Roberts DJ, Massey V, Morris J, Verlander NQ, Saei A, Young N, Makhani S, Wilcox D, Davies G, White S, et al. The effect of community water fluoridation on dental caries in children and young people in England: an ecological study. J Public Health (Oxf). 2023;45(2):462–9.

    Article  PubMed  Google Scholar 

  35. Mossey PA, Shaw WC, Munger RG, Murray JC, Murthy J, Little J. Global oral health inequalities: challenges in the prevention and management of orofacial clefts and potential solutions. Adv Dent Res. 2011;23(2):247–58.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  36. Ward ZJ, Goldie SJ. Global Burden of Disease Study 2021 estimates: implications for health policy and research. Lancet. 2024;403(10440):1958–9.

    Article  PubMed  Google Scholar 

  37. Goswami M, Saxena B, Tuli S, Shakil B, Bhatara S, Padha S. Global oral health policies and recommendations for children with special health care needs and their applicability and effectiveness during the COVID -19 pandemic: a systematic review. Evid Based Dent. 2024;25(2):113–113.

    Article  PubMed  Google Scholar 

  38. Ettinger RL. Epidemiology of dental caries. A broad review. Dent Clin North Am. 1999;43(4):679–694 vii.

    Article  PubMed  CAS  Google Scholar 

  39. Schwendicke F, Dörfer CE, Schlattmann P, Foster Page L, Thomson WM, Paris S. Socioeconomic inequality and caries: a systematic review and meta-analysis. J Dent Res. 2015;94(1):10–8.

    Article  PubMed  CAS  Google Scholar 

  40. Mahboobi Z, Pakdaman A, Yazdani R, Azadbakht L, Montazeri A. Dietary free sugar and dental caries in children: a systematic review on longitudinal studies. Health Promot Perspect. 2021;11(3):271–80.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Hung M, Licari FW, Hon ES, Lauren E, Su S, Birmingham WC, Wadsworth LL, Lassetter JH, Graff TC, Harman W, et al. In an era of uncertainty: Impact of COVID-19 on dental education. J Dent Educ. 2021;85(2):148–56.

    Article  PubMed  Google Scholar 

  42. Goriuc A, Sandu D, Tatarciuc M, Luchian I. The impact of the COVID-19 pandemic on dentistry and dental education: a narrative review. Int J Environ Res Public Health. 2022;19(5):2537.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  43. Shu J, Jin W. Prioritizing non-communicable diseases in the post-pandemic era based on a comprehensive analysis of the GBD 2019 from 1990 to 2019. Sci Rep. 2023;13(1):13325.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  44. Singh Thakur J, Nangia R, Singh S. Progress and challenges in achieving noncommunicable diseases targets for the sustainable development goals. FASEB Bioadv. 2021;3(8):563–8.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Collaborators GRF. Global burden of 87 risk factors in 204 countries and territories 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1223–49.

    Article  Google Scholar 

  46. Collaborators GDaH. Global regional and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1260–344.

    Article  Google Scholar 

  47. Bloom D, Cafiero-Fonseca E, Jane L, Eva AG, Shafika B, Lakshmi F, Sana F, Andrea G, Tom H, Ali M, Mona O'F, Danny O, Emre P, Ankur P, Klaus R, Larry S, Benjamin S, Adam W, Cara WJ. The Global Economic Burden of Noncommunicable Diseases. 2011. 

  48. Alderwick H, Hutchings A, Briggs A, Mays N. The impacts of collaboration between local health care and non-health care organizations and factors shaping how they work: a systematic review of reviews. BMC Public Health. 2021;21(1):753.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Collaborators GDaI. Global burden of 369 diseases and injuries in 204 countries and territories 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204–22.

    Article  Google Scholar 

  50. Hu W, Yang J. Effect of ambient ozone pollution on disease burden globally: a systematic analysis for the global burden of disease study 2019. Sci Total Environ. 2024;926:171739.

    Article  PubMed  CAS  Google Scholar 

  51. Ferrari AJ, Charlson FJ, Norman RE, Flaxman AD, Patten SB, Vos T, Whiteford HA. The epidemiological modelling of major depressive disorder: application for the Global Burden of Disease Study 2010. PLoS One. 2013;8(7):e69637.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

Download references

Acknowledgements

We are grateful for the work of the Global Burden of Disease study 2021 collaborators.

Clinical trial number

Not applecable.

Funding

None.

Author information

Authors and Affiliations

  1. GBD Collaborator, Nanjing Stomatological Hospital, Medical School of Nanjing University, 22 Hankou Road, Nanjing, 210093, China

    Zhiyuan Li

  2. Wuxi Stomatological Hospital, 6 Jiankang Road, Wuxi, 214000, China

    Chenhang Yu

  3. Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, Republic of Korea

    Huan Chen

Authors
  1. Zhiyuan Li
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Chenhang Yu
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Huan Chen
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

Zhiyuan Li: Formal analysis, Investigation, Methodology, Data curation, Software, Investigation, Writing. Chenhang Yu: Conceptualization, Resources, Data curation, Writing, review & editing, Supervision, Project administration. Huan Chen: review & editing.

Corresponding authors

Correspondence to Chenhang Yu or Huan Chen.

Ethics declarations

Ethics approval and consent to participate

The study was conducted using publicly available data and did not involve any human subjects or interventions that required direct interaction or manipulation. Therefore, according to the guidelines of our institution's ethics committee, no further ethics approval was required for this type of research. In accordance with the ethical principles outlined in the Declaration of Helsinki, all participants provided informed consent before participating in the study. The anonymity and confidentiality of the participants were guaranteed, and participation was completely voluntary.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, Z., Yu, C. & Chen, H. Global, regional, and national caries of permanent teeth incidence, prevalence, and disability-adjusted life years, 1990-2021: analysis for the global burden of disease study. BMC Oral Health 25, 715 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12903-025-06086-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12903-025-06086-z

Keywords

BMC Oral Health

ISSN: 1472-6831

Contact us