AdobeStock Largely preventable, oral diseases are the most common health condition in Latin America and the Caribbean — and have held this position for at least three decades. In 2023, cavities, advanced gum disease and tooth loss affected 308.2 million people in the region, more than any other disease, according to a study published in the scientific journal The Lancet Regional Health – Americas. The survey is part of the Global Burden of Disease Study (GBD), conducted by the Institute for Health Metrics and Evaluation (IHME), at the University of Washington, in the United States, and funded by the Gates Foundation. The analysis brings together estimates from 33 countries between 1990 and 2023, with projections for 2050, and was coordinated by epidemiologist Rafael Lozano, with the participation of Brazilian researchers. Among all the diseases and conditions catalogued, oral conditions lead the prevalence ranking — the number of people living with the problem at a given time — in 1990, 2000 and 2023. In the last year analyzed, they accounted for 53.7% of all cases of ongoing disease in the region, more than half of the total. In terms of the number of new cases each year, they ranked third, behind only upper respiratory tract infections and Covid-19 — before the pandemic, they occupied second place. Despite the slight drop in the number of new cases over the period, the prevalence and disability associated with these problems have remained practically stable since 1990. For the authors, this is a sign of the limited scope of prevention strategies and the secondary place that oral health occupies in the region's health policies. World Oral Health Day: See how to prevent diseases and cavities A problem that changes shape throughout life More than a static portrait, the study describes a disease that changes with age. In childhood, cavities in baby teeth predominate, reaching a peak between the ages of 5 and 9. In youth and adulthood, cavities in permanent teeth take the lead, more frequent around the age of 40 to 44. In older age groups, severe periodontitis —an advanced form of gum disease— and edentulism, the total loss of natural teeth, gain weight. This transition has a direct effect on the disability generated. The researchers measured this impact in years lived with disability (AVI), an indicator that estimates the time a person spends living with the limitations of a disease. Cavities in baby teeth are almost irrelevant to this calculation; Edentulism is now the main responsible for the loss of quality of life among the elderly. Alone, total tooth loss accounted for 1.3 million of the 2.41 million AVI recorded in 2023 — more than half of the entire impact caused by oral diseases in the region. Where Brazil appears The burden varies greatly from one country to another, reflecting structural inequalities. Among children aged 1 to 9 years, the highest rates of disability due to cavities in baby teeth were recorded in Belize and Paraguay, while Brazil and Colombia were among the lowest. From 1990 to 2023, Chile, Argentina and Uruguay achieved reductions of more than 15%; Mexico, Paraguay and several Central American countries have made virtually no progress. In permanent teeth, the highest rates appeared in Chile, Bolivia and Ecuador — about double those in Mexico. Severe periodontitis, meanwhile, was most disabling in Bermuda, Puerto Rico and Uruguay, almost twice as much as in Guatemala and Honduras, with most countries reporting an increase of 25% or more since 1990. In terms of edentulism, Brazil appears among the most affected: the highest rates of disability due to tooth loss among adults aged 60 or over were observed in Bolivia, Peru and Brazil itself. At the other end, Chile and Colombia are among the lowest indices, with drops of more than 15% in the period. A pattern impressed the researchers: more developed countries tend to record less total tooth loss, but more disability linked to severe periodontitis — a possible reflection of the fact that, in these places, more people reach old age with their natural teeth and, with them, exposed to gum disease. Preventable but overlooked The persistence of the problem, according to the study, is directly linked to access to prevention measures. Where fluoride toothpaste is affordable and routine dental examination is available, the burden tends to be lower. Countries such as Brazil, Chile, Mexico, Colombia and Peru already provide fluoride to the majority of the population through toothpaste, water or salt — an effective strategy against childhood cavities. Still, the burden among adults remains high. For researchers, the data reveals the limits of concentrating efforts only on fluoride, leaving factors such as diet, smoking and access to rehabilitative treatment in the background. The gaps are most visible among rural, indigenous and socially excluded populations, poorly served by both prevention and treatment. Brazil is cited as one of the few countries in the region —along with Colombia— to maintain systematic monitoring of oral health. In most of the continent, monitoring is still scarce and fragmented, which makes comparisons between countries and the design of public policies difficult. What to expect until 2050 The aging of the population should significantly increase the number of people living with disabilities linked to oral health. Between 1990 and 2023, the years lived with disability almost doubled, from 1.02 million to 2.41 million. The projection is that they will reach 3.81 million in 2050, with edentulism and severe periodontitis as the main culprits. To change this path, the authors advocate that oral health be incorporated into primary health care and universal health coverage, with an approach that accompanies people at all stages of life — from childhood to old age. They also point to the need to address the social and commercial determinants of the problem, such as sugar consumption and smoking, with measures that include taxing sugary drinks and tobacco products. The study recognizes limitations. Of the 33 countries analyzed, 14 — the majority in the Caribbean — did not have primary data on the topic, which increases the uncertainty of the estimates. Furthermore, edentulism was only counted as total tooth loss, which may underestimate the real impact of partial loss, common among the elderly and capable of compromising chewing and nutrition.