Global, Regional, and National Levels and Trends in Burden of Dental Caries and Periodontal Disease from 1990 to 2035：Result From the Global Burden of Disease Study 2021

Global, Regional, and National Levels and Trends in Burden of Dental Caries and Periodontal Disease from 1990 to 2035：Result From the Global Burden of Disease Study 2021 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Global, Regional, and National Levels and Trends in Burden of Dental Caries and Periodontal Disease from 1990 to 2035：Result From the Global Burden of Disease Study 2021 Jiangqiuchen Wu, Jinhao Chen, Cunming Lv, leilei Zhou This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5609270/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 May, 2025 Read the published version in BMC Oral Health → Version 1 posted 9 You are reading this latest preprint version Abstract Background The global burden of dental caries (DC) and periodontal disease (PD) has evolved significantly from 1990 to 2021, influenced by demographic shifts and socioeconomic factors in oral health interventions. This study aims to analyze historical trends, project future trajectories to 2035, and identify inequalities to inform equitable oral health policy development. Methods Utilizing data from the 2021 Global Burden of Disease Study (GBD), we analyzed incidence ,prevalence, age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) of caries of deciduous teeth (CDT), caries of permanent teeth (CPT) and PD from 1990 to 2021. Bayesian age-period-cohort (BAPC) models with Integrated Nested Laplace Approximation (INLA) were employed to forecast trends through 2035, integrating second-order smoothing effects, overdispersion adjustments, and uncertainty quantification via 1,000 Monte Carlo simulations (95% UI) with future precision expressed as 95% confidence intervals (CI). Results From 1990 to 2021, CDT prevalence declined regionally, while PD remained prevalent, particularly among middle-aged and elderly populations in high-burden regions like Sub-Saharan Africa and Southeast Asia. Significant gender disparities were noted, with females experiencing comparable deciduous DC in early childhood, whereas males showed dominant PD rates in middle/older ages. Low-income regions still face high burdens despite progress. Projections to 2035 suggest a CDT resurgence and aging-driven PD persistence. Conclusions DC and PD persist as major public health issues, shaped by gender, age, and regional disparities. The projected resurgence of childhood DC and persistent PD prevalence by 2035 underscore the need for targeted interventions. Tailored public health initiatives are essential to mitigate long-term impacts and improve global oral health outcomes. Global burden Dental caries Periodontal disease Oral health disparities Public health interventions Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 1. Introduction The WHO's Global Oral Health Status Report (2022) estimates that nearly 3.5 billion people, or 50% of the global population, suffer from oral diseases, with dental caries (DC) and periodontal disease (PD) being among the most prevalent, contributing significantly to the global health burden[ 1 ]. DC, classified into caries of deciduous teeth (CDT) and caries of permanent teeth (CPT), remains the leading cause of tooth destruction from early childhood through old age[ 2 , 3 ]. The high prevalence of CDT in children severely impacts their oral health and overall development, affecting their ability to learn and absorb nutrients[ 4 – 6 ]. While CPT is more commonly observed in adults, its burden remains significant, particularly as individuals age and, especially in the absence of proper oral health interventions[ 7 , 8 ]. PD, a chronic inflammatory disease that progressively destroys the supporting structures of the teeth, primarily affects middle-aged and elderly populations, and is a major cause of tooth loss[ 9 , 10 ]. In addition to its significant health impact, the economic burden of oral diseases is also considerable. In 2019, the global cost of oral diseases reached $ 710 billion, encompassing both treatment expenses and lost work productivity. Poor oral health not only undermines physical health but also adversely affects economic well-being by leading to missed school days, lower academic performance, reduced job opportunities, and diminished work productivity[ 11 ]. According to the World Health Organization, the global prevalence of CDT is as high as 43%, far exceeding the prevalence of CPT, making it a focal point of global oral health concerns[ 12 ]. While CPT is widely present in adult populations, CDT not only affects children's oral health but can also have long-lasting negative effects on their growth, development, nutrition, and learning capabilities[ 13 , 14 ]. Due to the smaller size and thinner enamel of primary teeth, caries develops more rapidly, and untreated caries can lead to more severe complications, further affecting the normal development of teeth[ 15 ]. Therefore, this study will focus on the distinct characteristics and risks of CDT and CPT. The Global Burden of Disease (GBD) study provides a comprehensive framework for evaluating the prevalence and health burden of various diseases worldwide, and is particularly valuable in analyzing trends and changes in oral diseases[ 16 ]. Based on extensive data from 1990 to 2021, the GBD study has revealed the global burden of CDT, CPT, and PD. It provides detailed analytical tools that allow for the identification of burden disparities across gender, age groups, and regions[ 17 ]. By systematically analyzing these trends, the GBD study offers robust data support for future public health interventions and provides a scientific basis for more precise oral health policies, optimized resource allocation, and strengthened preventive measures[ 18 ]. This study aims to analyze historical trends and project future trajectories of CDT, CPT, and PD through 2035, with the overarching purpose of informing targeted policy interventions by examining global trends, gender disparities, age-specific patterns, and regional variations in disease burden. 2. Material Methods 2.1. Data sources The GBD 2021 study systematically evaluated the global health burden by quantifying incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for 369 diseases and injuries across 204 countries and territories between 1990 and 2021. To accurately measure the burden of DC and PD, GBD researchers integrated data from systematic literature reviews, national health surveys, longitudinal cohort studies, and clinical records into DisMod MR-2.1—a Bayesian meta-regression model tailored for disease burden research—while examining 204 countries and territories, which were further organized into 21 regional groupings and seven super-regional clusters to generate comparable burden estimates across different populations and time periods[ 19 , 20 ]. This study utilizes data from the 2021 GBD study to assess the incidence, prevalence, and their corresponding age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) for three oral diseases (CDT, CPT, and PD). All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting[ 21 ]. The case definition for DC is “teeth with unmistakable coronal cavity at dentin level, root cavity in cementum that feel soft or leathery to probing, temporary or permanent restorations, or missing teeth extracted due to a caries lesion”. Excluded definitions include crowns with isolated cosmetic defects, stained enamel pits, or fissures without visible cavitation or softening, fluorosis, and abrasion lesions. We elected to model deciduous caries and permanent caries as separate entities and then add the estimates together for an overall estimation of the global burden of DC. This is the modelling approach which has been taken in each iteration since GBD 2010 This definition corresponds to an ICD-9 code of 521.0 and an ICD-10 code of K02.3–K02.9[ 22 ]. The GBD definition of disability associated with symptomatic severe PD is “bad breath, a bad taste in the mouth, and gums that bleed a little from time to time, but which does not interfere with daily activities”. The ICD-10 codes for PD are K05.0–K05.6, and the ICD-9 codes are 523.0–523.9[ 22 ]. 2.2. Statistical Analysis We used the incidence, prevalence, ASIR and ASPR from the GBD database to evaluate the impact and patterns of DC and PD across different genders, age groups, and regions. The BAPC analysis employed the Integrated Nested Laplace Approximation (INLA) method[ 23 ]. To ensure data smoothness, the BAPC model assumes that the second-order differences of all effects follow independent normal distributions with a mean of zero. In the model, prior distributions for age and period effects were appropriately specified to capture variations in prevalence rates[ 24 ]. Specifically, the study estimated the number and rate of disease cases for future periods and incorporated an independent random effect to adjust for overdispersion[ 23 ]. In this investigation, projections of DC and PD-related ASPR for 2022–2035 were generated. Summary estimates for all variance parameters (including the mean, standard deviation, 5% quantile, median, and 95% quantile) are presented in Additional file (Supplementary Table 23–28). 2.2.1. Uncertainty Analysis All estimates were provided with 95% uncertainty intervals (UI), calculated through 1,000 Monte Carlo simulations to quantify the uncertainty of the estimates[ 25 ]. For the future predictions, 95% confidence intervals (CI) were used to express the precision of the data[ 26 ]. 2.2.2. Statistical Tools In this study, the R software package (version 4.3.3) was used for data processing, statistical analysis, and drawing the figures. 3. Results 3.1. Global Trends (2021): PD Highest Worldwide; DC Concentrated in Poor Area According to the 2021 age-standardized data, PD have the lowest global ASIR, with 1,069.44 per 100,000 people (95% UI: 942.71–1,204.58), significantly lower than CPT at 29,777.03 per 100,000 (95% UI: 26,310.27–33,490.91) and CDT at 17,781.15 per 100,000 (95% UI: 13,952.40–23,035.44). The highest rates of PD are observed in the Caribbean at 1,138.31 per 100,000 (95% UI: 943.48–1,335.36) and Central Latin America at 1,196.97 per 100,000 (95% UI: 1,033.36–1,365.93), while high-income regions like Western Europe have lower rates, at 841.70 per 100,000 (95% UI: 694.51–1,008.33). CPT, the most prevalent condition globally, peaks in South Asia at 31,398.81 per 100,000 (95% UI: 27,644.28–35,248.05) and Tropical Latin America at 36,541.09 per 100,000 (95% UI: 31,903.79–41,303.27), but remains high even in High-income North America at 30,898.22 per 100,000 (95% UI: 26,814.08–34,828.49). Although less common than CPT, CDT is more prevalent in Southeast Asia at 20,366.78 per 100,000 (95% UI: 15,172.99–29,250.65) and Southern Sub-Saharan Africa at 18,238.40 per 100,000 (95% UI: 13,484.31–23,381.99). In South Asia, the ASIR is 17,488.24 per 100,000 (95% UI: 13,708.08–22,367.38), which is in line with the global average ( Fig. 1 , Supplementary Fig. 1–2, Supplementary Table 1–4). 3.2. Gender Differences (2021): Gender-Similar in DC; Male-Dominant PD with Aging In females aged 2–4 years, CDT has an incidence rate of 63,091 cases per 100,000 people (95% UI: 45,274–81,082) and a prevalence rate of 51,043 cases per 100,000 people (95% UI: 39,599–61,503). For males in the same age group, the incidence rate is 62,606 cases per 100,000 people (95% UI: 44,751–80,195), and the prevalence rate is 52,060 cases per 100,000 people (95% UI: 40,473–62,402). These numbers indicate that CDT rates in early childhood are comparable between sexes, with females showing marginally higher incidence and slightly lower prevalence than males (Fig. 2 A-B, Supplementary Table 5–6). For CPT, females and males exhibit comparable incidence rates in adolescence. The incidence rate in females aged 15–19 is 46,126 cases per 100,000 people (95% UI: 36,363–56,627), closely matching males (46,311; 36,297–56,805). By age 20–24, female incidence rate rises to 54,162 (95% UI: 43,928–63,506), while males show a similar increase to 54,484 (44,523–63,599). Both sexes demonstrate progressive risk escalation in early adulthood, with no clear evidence of earlier onset in females. (Fig. 2 C-D, Supplementary Table 7–8). In the case of PD, females exhibit a progressive increase in prevalence rate from 4,249 cases per 100,000 people (95% UI: 2,836–6,115) at ages 20–24 to 13,577 cases per 100,000 (95% UI: 9,564–18,310) by ages 30–34. In contrast, males demonstrate consistently higher prevalence rate across all age groups, peaking at 30,512 cases per 100,000 (95% UI: 24,523–36,129) in the 50–54 age group. Incidence rate for males aged 50–54 are 1,883 per 100,000 (95% UI: 1,225–2,471). These findings indicate that males face a higher burden of PD compared to females, particularly in middle and older age groups. (Fig. 2 E-F, Supplementary Table 9–10). 3.3. Age Differences (1990–2021): Childhood-Adolescent DC Spike in High-Income Regions; Mid-Adulthood PD Drops in Vulnerable Populations In the 2021 data, CDT incidence rate in the 2–4 age group increased in high-income regions such as North America (High-income North America), from 50,953 cases per 100,000 people (95% UI: 26,664–81,244) in 1990 to 62,195 cases per 100,000 people (95% UI: 38,499–89,426) in 2021, an increase of 11,242 cases. In Australasia, the 5–9 age group saw a sharp rise in incidence rate from 31,838 cases per 100,000 people (95% UI: 23,353–40,203) in 1990 to 74,543 cases per 100,000 people (95% UI: 50,997–101,639) in 2021, an increase of 42,705 cases. For the 10–14 age group in Australasia, incidence rate increased from 98,577 cases per 100,000 people (95% UI: 85,042–114,212) in 1990 to 116,847 cases per 100,000 people (95% UI: 59,428–162,169) in 2021, while prevalence rate surged from 6,692 cases per 100,000 people (95% UI: 5,736–7,662) to 14,081 cases per 100,000 people (95% UI: 10,649–17,713) (Fig. 3 A-B, Supplementary Table 11–12). For CPT, in the 15–19 age group, East Asia saw a substantial increase in incidence rate, rising from 21,716 cases per 100,000 people (95% UI: 19,544–23,888) in 1990 to 41,774 cases per 100,000 people (95% UI: 37,597–45,952) in 2021.In the 20–24 age group, Southeast Asia experienced a slight increase in incidence rate, from 55,750 cases per 100,000 people (95% UI: 44,116–65,876) in 1990 to 57,159 cases per 100,000 people (95% UI: 46,406–66,440) in 2021. In the 45–49 age group, East Asia showed an increase in incidence rate, rising from 16,838 cases per 100,000 people (95% UI: 12,922–21,749) in 1990 to 20,150 cases per 100,000 people (95% UI: 15,290–26,495) in 2021. (Fig. 3 C-D, Supplementary Table 13–14). Additionally, the most notable changes in the incidence rate of PD were observed in the following age groups and regions. In the 25–29 age group, Central Sub-Saharan Africa saw a significant decrease in incidence rate, from 2,208.82 cases per 100,000 people (95% UI: 1,152.97–3,256.40) in 1990 to 935.18 cases per 100,000 people (95% UI: 417.99–1,901.74) in 2021. In Oceania, the 30–34 age group experienced a sharp decline, with the incidence rate falling from 1,073.71 cases per 100,000 people (95% UI: 531.81–1,847.56) in 1990 to 217.43 cases per 100,000 people (95% UI: 100.78–447.87) in 2021.For the 50–54 age group, Oceania again showed a large reduction, with the incidence rate dropping from 2,032.57 cases per 100,000 people (95% UI: 1,169.61–2,891.48) in 1990 to 526.18 cases per 100,000 people (95% UI: 212.51–1,102.17) in 2021. ( Fig. 3 E-F, Supplementary Table 15–16). 3.4. Regional Differences (1990–2021): DC Rises in Affluent Regions; PD Drops in Poor Areas From 1990 to 2021, the ASIR of CDT in Sub-Saharan Africa decreased by 12.02% (UI: -22.38% – 5.67%), while prevalence rate also declined by 6.20% (UI: -15.54% – 6.63%). During the same period, Southeast Asia saw a slight increase in the ASIR of CDT by 0.57% (UI: -2.31% – 3.61%) and a ASPR change of -2.70% (UI: -4.55% – -0.86%). North America experienced a 10.88% rise in the ASIR of CDT (UI: -0.92% – 31.61%) and a 20.08% increase in ASPR (UI: 8.43% – 35.79%) from 1990 to 2021. Western Europe reported a reduction in the ASIR of CDT by 6.62% (UI: -16.65% – 1.63%) and a ASPR change of -17.31% (UI: -24.20% – -10.47%) during the same timeframe. ( Fig. 4A-B, Supplementary Table 17–18). Regarding CPT, East Asia saw a significant increase in ASIR by 31.20% (UI: 22.31% – 44.87%) from 1990 to 2021, whereas South Asia experienced a modest rise of 1.68% (UI: -0.75% – 4.07%). In North America, the ASIR of CPT decreased by 2.98% (UI: -6.03% – 0.18%) over the 1990–2021 period, while Northern Europe had a slight increase of 0.53% (UI: -3.08% – 4.70%) and Western Europe rose by 0.53% (UI: -3.08% – 4.70%). In terms of ASPR, East Asia saw a decrease of 0.94% (UI: -8.73% – 7.67%), South Asia decreased by -5.74% (UI: -7.48% – -3.46%), North America decreased by -5.13% (UI: -8.54% – -1.35%), Northern Europe rose by 2.83% (UI: -0.47% – 6.60%), and Western Europe decreased by -8.91% (UI: -13.53% – -4.07%) in CPT ASPR from 1990 to 2021. ( Fig. 4C-D, Supplementary Table 19–20). Concerning PD, Sub-Saharan Africa experienced a significant decline in ASIR by -29.26% (UI: -40.45% – -13.51%) from 1990 to 2021, with Western Sub-Saharan Africa showing an even greater decrease of -34.78% (UI: -42.87% – -23.80%). In Southeast Asia, the ASIR of PD changed by -8.46% (UI: -17.34% – 4.52%) during this period, while North America saw a -5.88% change (UI: -18.45% – 11.71%). Western Europe reported a decrease in PD ASIR by -9.50% (UI: -27.51% – 15.06%) from 1990 to 2021. ( Fig. 4E-F, Supplementary Table 21–22). 3.4. BAPC Prediction (2021–2035): Resurgence in Childhood CDT; Improvement in Adolescent CPT ; Deterioration of PD in Middle-Aged/Elderly Populations From 1990 to 2020, the overall ASPR of CDT gradually declined from 28,108.90 cases per 100,000 (95% UI: 28,106.42–28,111.39) to 26,796.70 cases per 100,000 (95% UI: 26,794.43–26,798.98), with projections indicating a rise to 29,447.78 cases per 100,000 (95% CI: 21,840.17–37,055.39) by 2035. Among children under 5 years of age, prevalence rate decreased from 35,008.79 cases per 100,000 (95% UI: 35,002.69–35,014.90) in 1990 to 33,917.97 cases per 100,000 (95% UI: 33,912.01–33,923.93) in 2020, and is projected to increase to 43,626.47 cases per 100,000 (95% CI: 34,236.60–53,016.34) by 2035.Additionally, for children aged 5–9 years, prevalence rate declined from 41,641.48 cases per 100,000 (95% UI: 41,635.10–41,647.86) in 1990 to 39,735.10 cases per 100,000 (95% UI: 39,729.09–39,741.10) in 2020, with an anticipated rise to 43,626.47 cases per 100,000 (95% CI: 34,236.60–53,016.34) by 2035. Among those aged 10–14 years, prevalence rate decreased from 6,080.48 cases per 100,000 (95% UI: 6,072.15–6,088.80) in 1990 to 4,910.58 cases per 100,000 (95% UI: 4,901.78–4,919.38) in 2020, and is expected to reach 5,590.75 cases per 100,000 (95% CI: 4,889.02–6,292.47) by 2035. (Fig. 5 A, Supplementary Fig. 3,Supplementary Table 23–24). The prevalence of CPT changed differently across age groups from 2022 to 2035. For the 5–9 age group, cases fell sharply from 9,496.63 per 100,000 (95% UI: 9,489.29–9,503.97) in 1990 to 8,060.55 (95% UI: 8,052.92–8,068.18) in 2021, and will likely drop further to 7,163.20 (95% CI: 5,540.37–8,786.02) by 2035. For the 10–14 age group, cases also decreased from 26,313.72 (95% UI: 26,307.46–26,319.97) to 23,989.37 per 100,000 (95% UI: 23,983.38–23,995.36) between 1990 and 2021, and are expected to reach 21,217.69 (95% CI: 18,304.92–24,130.45) by 2035.In the 15–19 age group, cases had a small decrease from 30,747.88 (95% UI: 30,741.53–30,754.23) to 30,718.23 per 100,000 (95% UI: 30,712.19–30,724.27) from 1990 to 2021, but predictions show a bigger drop to 27,141.72 (95% CI: 25,177.03–29,106.40) by 2035. For the 20–24 age group, cases went down from 39,396.96 (95% UI: 39,390.27–39,403.65) to 38,039.96 per 100,000 (95% UI: 38,033.73–38,046.20) during this period, and may decrease to 35,517.78 (95% CI: 33,768.35–37,267.20) by 2035. In the 25–29 age group, cases slightly declined from 38,100.12 (95% UI: 38,093.23–38,107.01) to 37,842.43 per 100,000 (95% UI: 37,836.17–37,848.69), with a predicted fall to 35,327.53 (95% CI: 32,604.31–37,050.76) by 2035.However, the 65–69 age group was different. Their cases rose from 34,168.14 (95% UI: 34,157.09–34,179.19) in 1990 to 32,432.73 per 100,000 (95% UI: 32,424.86–32,440.59) in 2021, and are expected to keep rising to 32,336.81 (95% CI: 30,707.38–33,905.99) by 2035. ( Fig. 5 B, Supplementary Fig. 4,Supplementary Table 25–26). For PD, the overall ASPR decreased slightly from 28,250.67 (95% UI: 28,242.56–28,258.77) in 1990 to 27,605.47 (95% UI: 27,598.21–27,612.73) in 2021, with projections indicating a decrease to 28,607.75 (95% CI: 28,516.43–28,699.07) by 2035.The 50–54 age group exhibited a decline from 30,745.90 per 100,000 (95% UI: 30,736.34–30,755.46) in 1990 to 29,595.13 (95% UI: 29,588.50–29,601.75) in 2021, projected to reach 32,136.12 (95% CI: 31,336.74–32,935.51) by 2035.Other age groups also demonstrated notable trends. For individuals aged 15–19 years, the prevalence rate increased from 1,127.70 (95% UI: 1,114.99–1,140.40) in 1990 to 1,305.39 (95% UI: 1,293.10–1,317.69) in 2021, with a projected prevalence rate of 1,167.90 (95% CI: 819.15–1,516.65) by 2035.Among individuals aged 20–24 years, prevalence rate increased from 3,725.77 (95% UI: 3,716.24–3,735.30) to 4,309.55 (95% UI: 4,300.42–4,318.69), with a predicted prevalence rate of 3,992.01 (95% CI: 3,215.78–4,768.25) by 2035.In the 30–34 age group, prevalence rate increased from 12,864.32 (95% UI: 12,857.21–12,871.43) to 13,751.46 (95% UI: 13,744.79–13,758.13), with an expected increase to 14,164.95 (95% CI: 12,619.11–15,710.78) by 2035.Additionally, the 65–69 age group saw a slight increase from 27,409.16 (95% UI: 27,398.93–27,419.39) in 1990 to 27,651.64 (95% UI: 27,644.03–27,659.24) in 2021, with a projected prevalence rate of 27,142.08 (95% CI: 24,210.45–30,073.71) by 2035. ( Fig. 5 C, Supplementary Fig. 5,Supplementary Table 27–28). 4. Discussion 4.1. Comprehensive Comparison of Temporal Trends and Future Predictions The temporal trends of CDT, CPT, and PD exhibit distinct epidemiological patterns. Between 1990 and 2021, the global ASPR of CDT declined from 28,108.90 to 26,796.70 cases per 100,000 people. However, the BAPC model projects a resurgence to 29,447.78 cases per 100,000 by 2035. This suggests that despite short-term public health successes, persistent inequalities in oral hygiene infrastructure—particularly in low-income regions—may drive a future rebound of CDT [ 27 ]. For CPT, while the global prevalence has decreased over the past three decades, its ASIR among adolescents and young adults (15–24 years) has risen sharply in specific regions. In East Asia, the incidence rate of CPT in the 15–19 age group surged between 1990 and 2021. Although economic development and dietary shifts may contribute to a projected slight decline in global CPT prevalence by 2035, the persistent rise in adolescent cases underscores the urgent need for targeted interventions in high-risk regions[ 11 , 28 – 30 ]. Meanwhile, PD demonstrates a divergent trajectory. Despite a modest decline in overall prevalence from 1990 to 2021, projections indicate a potential deterioration by 2035. This trend is particularly pronounced among middle-aged and elderly populations (e.g., in Oceania, the 50–54 age group saw incidence rate drop by 74% from 1990 to 2021, yet global prevalence remains high due to aging demographics). These patterns highlight the lifespan-specific nature of oral diseases: CDT and CPT predominantly affect children and adolescents, whereas PD disproportionately burdens older adults, necessitating age-tiered prevention—fluoride varnish programs in preschools and geriatric PD screening by non-dental health professionals in primary care systems [ 31 ]. 4.2. Comparison of Gender Differences and Public Health Implications Gender differences in oral health reveal nuanced disparities with public health implications. For CDT in early childhood, females show a marginally higher ASIR of 63,091 per 100,000 compared to males at 62,606 per 100,000 but slightly lower prevalence than males. This indicates comparable early-life exposure between sexes rather than a clear female disadvantage [ 32 ]. Regarding CPT, both sexes exhibit nearly identical incidence rates in adolescence, with females and males showing similar rates in the 15–19 and 20–24 age groups. This finding contrasts with some regional studies, which show more pronounced gender differences[ 33 , 34 ]. The reason for this discrepancy may be that, in these age groups, the global perspective of GBD studies, which involves a vast amount of data, masks inherent gender differences in risk, leading to similar rates of incidence across genders. Conversely, PD demonstrates a pronounced male-dominant burden with aging. While females show a progressive increase in prevalence rate from the 20–24 age group to the 30–34 age group, males exhibit substantially higher rates across all ages, peaking in the 50–54 age group. Male incidence rate in this group highlights an age-dependent escalation of risk. This aligns with projections that PD prevalence in males aged 50–54 will rise by 2035, emphasizing a critical need for targeted interventions [ 35 ]. These findings focus on two policy directions: early-life CDT prevention programs that require sex-neutral approaches and age-specific PD management for males, especially those over 50 years. The predicted rise of childhood CDT in high-income regions and ongoing PD burden in older males need strategies that combine screening, education, and socioeconomic interventions to address disparities, particularly through gender-neutral school fluoride initiatives and task-shifting PD care to nurses in low-resource settings [ 36 , 37 ]. 4.3. In-Depth Comparison of Age Differences Sustained public health efforts have led to a gradual decline in the prevalence of CDT among children under 5 years old, with a notable reduction observed from 1990 to 2020. However, projections indicate a concerning reversal, with the prevalence expected to surge by 2035. This resurgence is particularly pronounced in high-income regions, such as North America and Australasia. Among children aged 2–4, the incidence rate increased significantly from 1990 to 2021, and a similar trend was observed in the 5–9 age group. These trends highlight the growing need for targeted interventions to address emerging risk factors in affluent populations[ 12 ]. While CPT remains more prevalent than CDT globally, its overall prevalence has slightly decreased from 1990 to 2021, with projections indicating this decline will continue through 2035. However, a concerning trend emerges in East Asia, where the incidence of CPT among adolescents aged 15–19 more than doubled during the same period. This stark divergence highlights a dual burden: declining rates in high-income regions, contrasted with persistently high rates in low-income areas. These differences may be driven by dietary shifts and limited access to preventive care in the latter regions, calling for subsidized fluoride toothpaste distribution in East Asian schools and AI-powered teledentistry for elderly PD patients in Sub-Saharan Africa [ 37 , 38 ]. PD, which demonstrated the highest global incidence among the three conditions in 2021, presents a paradoxical trend. While its overall prevalence has decreased slightly, projections suggest a resurgence by 2035. The middle-aged and elderly populations face disproportionate risks, with males aged 50–54 experiencing the highest prevalence. Past research has indicated that periodontitis was highly prevalent in regions like Central Sub - Saharan Africa and Oceania[ 39 , 40 ]. However, alarmingly, these regions have recently reported dramatic declines in PD incidence, which might be attributed to underreporting rather than genuine progress, given persistent healthcare disparities. 4.4. Integrated Comparison of Regional Differences in Oral Health Regional disparities in oral disease prevalence and incidence are shaped by complex interactions between socioeconomic factors, healthcare infrastructure, and cultural practices. Data from 1990 to 2021 confirm that low-income regions, such as Sub-Saharan Africa and Southeast Asia, continue to face high burdens of CDT, driven by limited access to oral healthcare and nutritional challenges[ 41 ]. For instance, Sub-Saharan Africa experienced a 12.02% reduction in CDT incidence rate and a 6.20% decline in prevalence rate, while Southeast Asia saw a marginal 0.57% increase in CDT incidence rate alongside a 2.70% decrease in prevalence rate. These trends highlight persistent inequities in preventive care despite localized improvements[ 42 ]. In contrast, middle-income regions like East Asia reported a 31.20% surge in CPT incidence rate, likely tied to rapid dietary shifts and delayed public health responses. High-income regions, however, demonstrated divergent trajectories: North America saw a 10.88% rise in CDT incidence rate and 20.08% increase in prevalence rate, whereas Western Europe reduced CDT incidence rate by 6.62% and prevalence by 17.31%. Concurrently, CPT rates in North America and Northern Europe remained stable or declined modestly, underscoring the effectiveness of sustained preventive policies[ 3 , 43 ]. PD exhibited the most striking regional contrasts. Sub-Saharan Africa achieved significant progress, with PD incidence rate declining by 29.26% and Western Sub-Saharan Africa by 34.78%, likely due to targeted hygiene interventions. Conversely, high-income regions like North America and Western Europe reported minimal reductions in PD incidence rate. This stagnation aligns with projections of worsening PD burdens among aging populations, suggesting that lifestyle factors and sequelae of restorative treatments may offset gains from advanced healthcare systems, demanding policy integration of oral health into Sustainable Development Goals 3[ 44 ]. The current research has several methodological constraints that should be acknowledged. First, our analysis depended entirely on pre-existing datasets rather than original data collection[ 45 ]. This approach introduces potential inaccuracies because different geographic areas use inconsistent measurement standards and reporting formats. Second, while statistical modeling provided a useful framework for examining disease patterns, these computational tools have inherent simplifications. The models likely omitted important social and biological variables that jointly influence disease outcomes. Third, our descriptions of temporal trends primarily relied on point estimates of incidence changes without accounting for overlapping UIs between periods. This approach prioritizes clarity in reporting but may obscure potential uncertainties in interpreting true increases or declines[ 46 ]. Incorporating these factors in future studies could substantially improve the interpretation of epidemiological trends. 5. Conclusion In line with our aim to guide targeted oral health policy, GBD 2021 data highlight notable trends of DC and PD from 1990 to 2021. CDT declined in some high-income regions yet is projected to resurge by 2035, while CPT remains widespread in older populations, particularly in East Asia. PD persists among middle-aged and elderly males, with Sub-Saharan Africa facing substantial burdens. Low-income regions continue to shoulder disproportionate oral health inequalities. These findings underscore the need for age- and region-specific interventions to mitigate long-term effects and strengthen global oral health equity. Declarations 6.1. Ethics approval and consent to participate Our study utilized publicly accessible GBD data, thus eliminating the need for informed consent or ethical review. Since it exclusively used publicly accessible data that did not contain any confidential or personally identifiable patient information. Given the nature of the data, informed consent was not required, and no ethical review or patient consent was needed, ensuring both transparency and ethical integrity in using secondary, non-identifiable health data for our research. 6.2. Consent for publication The authors agree to publish. 6.3. Competing interests The authors declare no competing interests. 6.4. Acknowledgments We sincerely thank the Institute for Health Metrics and Evaluation at the University of Washington, the GBD collaborators, and all staff who provided data for this study. We also extend our gratitude to the GBDR research team for providing JD_GBDR (V2.36, Jingding Medical Technology Co., Ltd.). The views expressed in this paper are solely those of the authors and do not represent the official positions of their affiliated organizations. 6.5. Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research. 6.6. Authors’ contributions Jiangqiuchen Wu: Formal analysis, Data curation, Writing draft. Jiangqiuchen Wu ,Jinhao Chen : Writing-Original draft preparation, Results interpretation. Jiangqiuchen Wu ,Leilei Zhou: Data inspection and modification, Writing Revision Leilei Zhou ,Cunming Lv: Supervision, Reviewing and Editing 6.7. Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. 6.8. Availability of data and materials The datasets generated during and/or analyzed during the current study are available from the Global Health Data Exchange query tool (http://ghdx.healthdata.org/gbd-results-tool). References Jain N, Dutt U, Radenkov I, Jain S. WHO’s global oral health status report 2022: Actions, discussion and implementation. Oral Dis. 2024;30:73–9. Peres M, Macpherson L, Weyant R, Daly B, Venturelli R, Mathur M, et al. Oral diseases: a global public health challenge. Lancet. 2019;394:249–60. Kocher T, Meisel P, Baumeister S, Holtfreter B. Impact of public health and patient-centered prevention strategies on periodontitis and caries as causes of tooth loss in high-income countries. Periodontology 2000. 2024. https://doi.org/10.1111/prd.12592 Pierce A, Singh S, Lee J, Grant CG, de Jesus VC, Schroth R. 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Gender differences in knowledge, attitude, behavior and perceived oral health among adolescents. Acta Odontol Scand. 1999;57 4:231–6. Erchick D, Agrawal N, Khatry S, Katz J, LeClerq S, Rai B et al. Feasibility of training community health workers to conduct periodontal examinations: a validation study in rural Nepal. BMC Health Serv Res. 2020;20. Ruff R, Monse B, Duijster D, Itchon G, Naliponguit E, Benzian H. Effectiveness of school-based strategies to prevent tooth decay in Filipino children: A cluster-randomized trial. Community dentistry and oral epidemiology. 2022. https://doi.org/10.1111/cdoe.12729 Qi X, Wu B. AI’s Role in Improving Social Connection and Oral Health for Older Adults: A Synergistic Approach. JDR Clin Translational Res. 2024;9:196–8. Chikte U, Pontes CC, Karangwa I, Kimmie-Dhansay F, Erasmus R, Kengne A et al. Periodontal Disease Status among Adults from South Africa—Prevalence and Effect of Smoking. Int J Environ Res Public Health. 2019;16. 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The global, regional, and national patterns of change in the burden of congenital birth defects, 1990–2021: an analysis of the global burden of disease study 2021 and forecast to 2040. eClinicalMedicine. 2024;77:102873. Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959;22 4:719–48. Additional Declarations No competing interests reported. Supplementary Files SupplementaryTable1.xlsx SupplementaryTable2.xlsx SupplemenaryTable3.xlsx SupplemenaryTable4.xlsx SupplementaryTable5.xlsx SupplementaryTable6.xlsx SupplementaryTable7.xlsx SupplementaryTable8.xlsx SupplementaryTable9.xlsx SupplementaryTable10.xlsx SupplementaryTable11.xlsx SupplementaryTable12.xlsx SupplementaryTable13.xlsx SupplementaryTable14.xlsx SupplementaryTable15.xlsx SupplementaryTable16.xlsx SupplementaryTable17.xlsx SupplementaryTable18.xlsx SupplementaryTable19.xlsx SupplementaryTable20.xlsx SupplementaryTable21.xlsx SupplementaryTable22.xlsx SupplementaryTable23.xlsx SupplementaryTable24.xlsx SupplementaryTable25.xlsx SupplementaryTable26.xlsx SupplementaryTable27.xlsx SupplementaryTable28.xlsx SupplemenaryFigure1.pdf SupplemenaryFigure2.pdf SupplemenaryFigure3.pdf SupplemenaryFigure4.pdf SupplemenaryFigure5.pdf Cite Share Download PDF Status: Published Journal Publication published 29 May, 2025 Read the published version in BMC Oral Health → Version 1 posted Editorial decision: Revision requested 09 Apr, 2025 Reviews received at journal 08 Apr, 2025 Reviewers agreed at journal 08 Apr, 2025 Reviews received at journal 03 Apr, 2025 Reviewers agreed at journal 03 Apr, 2025 Reviewers agreed at journal 01 Apr, 2025 Reviewers invited by journal 01 Apr, 2025 Submission checks completed at journal 01 Apr, 2025 First submitted to journal 29 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5609270","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":436991912,"identity":"400899f3-81e2-41d1-ac07-342fe8574139","order_by":0,"name":"Jiangqiuchen Wu","email":"","orcid":"","institution":"Yichang Central People's Hospital, China Three Gorges University","correspondingAuthor":false,"prefix":"","firstName":"Jiangqiuchen","middleName":"","lastName":"Wu","suffix":""},{"id":436991913,"identity":"80ad2c92-1b71-4d4f-ad92-f460317acd9a","order_by":1,"name":"Jinhao Chen","email":"","orcid":"","institution":"China Three Gorges University","correspondingAuthor":false,"prefix":"","firstName":"Jinhao","middleName":"","lastName":"Chen","suffix":""},{"id":436991914,"identity":"4933d817-0e88-4847-a3ae-cfc2d6ce5cc1","order_by":2,"name":"Cunming Lv","email":"","orcid":"","institution":"China Three Gorges University","correspondingAuthor":false,"prefix":"","firstName":"Cunming","middleName":"","lastName":"Lv","suffix":""},{"id":436991915,"identity":"0395d949-c4c0-4c00-a02e-400240c9dcd4","order_by":3,"name":"leilei Zhou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvklEQVRIie3RMQrCMBTG8ZdJh6BrpZAbCJGAY71KQwdXR8eUgmfIMZycn2ToIrhadKiLrh0dOpiAg1vfKJj//P1IQgBisZ8MGbaAAKOybDsK4H6NeSDcVQtLI/AhyXqXjilkxcIp/U3I5m5SgEzMDeli/KHkVRu1gUItkUQSp/eeFBZQH2hEetIcjeN0kntyYWVFIxgIOjU76YpZSXjLyCJru96JSV0/X902E4MEkvP3l8uheWhqKKtYLBb76946HU40xq0VNwAAAABJRU5ErkJggg==","orcid":"","institution":"Tongji Hospital","correspondingAuthor":true,"prefix":"","firstName":"leilei","middleName":"","lastName":"Zhou","suffix":""}],"badges":[],"createdAt":"2024-12-09 13:08:39","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5609270/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5609270/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12903-025-06108-w","type":"published","date":"2025-05-29T15:57:14+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":79791859,"identity":"d3ff6246-9d11-457d-8fde-64eeb1799c7b","added_by":"auto","created_at":"2025-04-02 19:17:49","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":2090225,"visible":true,"origin":"","legend":"\u003cp\u003eHeatmap present incidence (A) and prevalence (B) for CDT, CPT and PD by location in 2021 .The colors in the figure represent rankings from high (red) to low (blue). 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19:01:45","extension":"xlsx","order_by":21,"title":"","display":"","copyAsset":false,"role":"supplement","size":93353,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTable21.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-5609270/v1/8306b4777b829537644cce80.xlsx"},{"id":79791337,"identity":"5614e2b1-ed18-4d2a-b6af-a0b79f2376f2","added_by":"auto","created_at":"2025-04-02 19:01:46","extension":"xlsx","order_by":22,"title":"","display":"","copyAsset":false,"role":"supplement","size":93844,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTable22.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-5609270/v1/18b226a846f677c2c6aca4f5.xlsx"},{"id":79791359,"identity":"ebe58def-6be6-44dd-b021-eb96d4dc80e0","added_by":"auto","created_at":"2025-04-02 19:01:48","extension":"xlsx","order_by":23,"title":"","display":"","copyAsset":false,"role":"supplement","size":27335,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTable23.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-5609270/v1/bdd9015ebdaac6a2e04ab1da.xlsx"},{"id":79791377,"identity":"7cebf533-f374-4293-b45f-8b9e05014010","added_by":"auto","created_at":"2025-04-02 19:01:49","extension":"xlsx","order_by":24,"title":"","display":"","copyAsset":false,"role":"supplement","size":11442,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTable24.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-5609270/v1/884e890d5afae81412e96747.xlsx"},{"id":79791746,"identity":"1a30b37e-2c8d-4244-bf12-e249a0a07fdc","added_by":"auto","created_at":"2025-04-02 19:09:46","extension":"xlsx","order_by":25,"title":"","display":"","copyAsset":false,"role":"supplement","size":11403,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTable25.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-5609270/v1/1aac8c28d7befc3620230b81.xlsx"},{"id":79791361,"identity":"d0ef2f1c-eea2-450f-9fd8-fe8a0c24d835","added_by":"auto","created_at":"2025-04-02 19:01:48","extension":"xlsx","order_by":26,"title":"","display":"","copyAsset":false,"role":"supplement","size":104177,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTable26.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-5609270/v1/2e98b5611d58f5168ed7e0f7.xlsx"},{"id":79791751,"identity":"9f08afa3-98d3-4717-acfb-176239d478e0","added_by":"auto","created_at":"2025-04-02 19:09:48","extension":"xlsx","order_by":27,"title":"","display":"","copyAsset":false,"role":"supplement","size":11386,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTable27.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-5609270/v1/7a8e18a7ae7ab67d9a0c5242.xlsx"},{"id":79791759,"identity":"dae790e8-e446-4861-bcaa-3de5238406dd","added_by":"auto","created_at":"2025-04-02 19:09:51","extension":"xlsx","order_by":28,"title":"","display":"","copyAsset":false,"role":"supplement","size":89569,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTable28.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-5609270/v1/384fb67a26aa1a41b73037a7.xlsx"},{"id":79791400,"identity":"913033a5-2abf-4c46-bab4-50cbb10a748b","added_by":"auto","created_at":"2025-04-02 19:01:51","extension":"pdf","order_by":29,"title":"","display":"","copyAsset":false,"role":"supplement","size":6553,"visible":true,"origin":"","legend":"","description":"","filename":"SupplemenaryFigure1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5609270/v1/b7ab9fe7b6b024fc5b06eaa7.pdf"},{"id":79791403,"identity":"0146dd14-f9f9-4896-b8f4-36ae53d6cba7","added_by":"auto","created_at":"2025-04-02 19:01:51","extension":"pdf","order_by":30,"title":"","display":"","copyAsset":false,"role":"supplement","size":6654,"visible":true,"origin":"","legend":"","description":"","filename":"SupplemenaryFigure2.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5609270/v1/3e107df28c39c006dc089672.pdf"},{"id":79791378,"identity":"4ce434a1-b321-47a3-97cb-df13dc2b1538","added_by":"auto","created_at":"2025-04-02 19:01:49","extension":"pdf","order_by":31,"title":"","display":"","copyAsset":false,"role":"supplement","size":14467,"visible":true,"origin":"","legend":"","description":"","filename":"SupplemenaryFigure3.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5609270/v1/89f582d8eadeb026afcc6898.pdf"},{"id":79791857,"identity":"51fc78a1-205f-4f34-8ddc-030ab235a9bc","added_by":"auto","created_at":"2025-04-02 19:17:47","extension":"pdf","order_by":32,"title":"","display":"","copyAsset":false,"role":"supplement","size":45540,"visible":true,"origin":"","legend":"","description":"","filename":"SupplemenaryFigure4.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5609270/v1/33ce7b3e6e1232c65d5283cd.pdf"},{"id":79791348,"identity":"5c7a915b-0fca-42ec-a2d0-173f66ce1e47","added_by":"auto","created_at":"2025-04-02 19:01:47","extension":"pdf","order_by":33,"title":"","display":"","copyAsset":false,"role":"supplement","size":39498,"visible":true,"origin":"","legend":"","description":"","filename":"SupplemenaryFigure5.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5609270/v1/881cc5a0f99fea7db11e3ff0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Global, Regional, and National Levels and Trends in Burden of Dental Caries and Periodontal Disease from 1990 to 2035：Result From the Global Burden of Disease Study 2021","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThe WHO's Global Oral Health Status Report (2022) estimates that nearly 3.5\u0026nbsp;billion people, or 50% of the global population, suffer from oral diseases, with dental caries (DC) and periodontal disease (PD) being among the most prevalent, contributing significantly to the global health burden[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. DC, classified into caries of deciduous teeth (CDT) and caries of permanent teeth (CPT), remains the leading cause of tooth destruction from early childhood through old age[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The high prevalence of CDT in children severely impacts their oral health and overall development, affecting their ability to learn and absorb nutrients[\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. While CPT is more commonly observed in adults, its burden remains significant, particularly as individuals age and, especially in the absence of proper oral health interventions[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. PD, a chronic inflammatory disease that progressively destroys the supporting structures of the teeth, primarily affects middle-aged and elderly populations, and is a major cause of tooth loss[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In addition to its significant health impact, the economic burden of oral diseases is also considerable. In 2019, the global cost of oral diseases reached \u003cspan\u003e$\u003c/span\u003e710\u0026nbsp;billion, encompassing both treatment expenses and lost work productivity. Poor oral health not only undermines physical health but also adversely affects economic well-being by leading to missed school days, lower academic performance, reduced job opportunities, and diminished work productivity[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to the World Health Organization, the global prevalence of CDT is as high as 43%, far exceeding the prevalence of CPT, making it a focal point of global oral health concerns[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. While CPT is widely present in adult populations, CDT not only affects children's oral health but can also have long-lasting negative effects on their growth, development, nutrition, and learning capabilities[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Due to the smaller size and thinner enamel of primary teeth, caries develops more rapidly, and untreated caries can lead to more severe complications, further affecting the normal development of teeth[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Therefore, this study will focus on the distinct characteristics and risks of CDT and CPT.\u003c/p\u003e \u003cp\u003eThe Global Burden of Disease (GBD) study provides a comprehensive framework for evaluating the prevalence and health burden of various diseases worldwide, and is particularly valuable in analyzing trends and changes in oral diseases[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Based on extensive data from 1990 to 2021, the GBD study has revealed the global burden of CDT, CPT, and PD. It provides detailed analytical tools that allow for the identification of burden disparities across gender, age groups, and regions[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. By systematically analyzing these trends, the GBD study offers robust data support for future public health interventions and provides a scientific basis for more precise oral health policies, optimized resource allocation, and strengthened preventive measures[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study aims to analyze historical trends and project future trajectories of CDT, CPT, and PD through 2035, with the overarching purpose of informing targeted policy interventions by examining global trends, gender disparities, age-specific patterns, and regional variations in disease burden.\u003c/p\u003e"},{"header":"2. Material Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Data sources\u003c/h2\u003e \u003cp\u003eThe GBD 2021 study systematically evaluated the global health burden by quantifying incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for 369 diseases and injuries across 204 countries and territories between 1990 and 2021. To accurately measure the burden of DC and PD, GBD researchers integrated data from systematic literature reviews, national health surveys, longitudinal cohort studies, and clinical records into DisMod MR-2.1\u0026mdash;a Bayesian meta-regression model tailored for disease burden research\u0026mdash;while examining 204 countries and territories, which were further organized into 21 regional groupings and seven super-regional clusters to generate comparable burden estimates across different populations and time periods[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This study utilizes data from the 2021 GBD study to assess the incidence, prevalence, and their corresponding age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) for three oral diseases (CDT, CPT, and PD). All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe case definition for DC is \u0026ldquo;teeth with unmistakable coronal cavity at dentin level, root cavity in cementum that feel soft or leathery to probing, temporary or permanent restorations, or missing teeth extracted due to a caries lesion\u0026rdquo;. Excluded definitions include crowns with isolated cosmetic defects, stained enamel pits, or fissures without visible cavitation or softening, fluorosis, and abrasion lesions. We elected to model deciduous caries and permanent caries as separate entities and then add the estimates together for an overall estimation of the global burden of DC. This is the modelling approach which has been taken in each iteration since GBD 2010 This definition corresponds to an ICD-9 code of 521.0 and an ICD-10 code of K02.3\u0026ndash;K02.9[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe GBD definition of disability associated with symptomatic severe PD is \u0026ldquo;bad breath, a bad taste in the mouth, and gums that bleed a little from time to time, but which does not interfere with daily activities\u0026rdquo;. The ICD-10 codes for PD are K05.0\u0026ndash;K05.6, and the ICD-9 codes are 523.0\u0026ndash;523.9[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Statistical Analysis\u003c/h2\u003e \u003cp\u003eWe used the incidence, prevalence, ASIR and ASPR from the GBD database to evaluate the impact and patterns of DC and PD across different genders, age groups, and regions. The BAPC analysis employed the Integrated Nested Laplace Approximation (INLA) method[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. To ensure data smoothness, the BAPC model assumes that the second-order differences of all effects follow independent normal distributions with a mean of zero. In the model, prior distributions for age and period effects were appropriately specified to capture variations in prevalence rates[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Specifically, the study estimated the number and rate of disease cases for future periods and incorporated an independent random effect to adjust for overdispersion[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In this investigation, projections of DC and PD-related ASPR for 2022\u0026ndash;2035 were generated. Summary estimates for all variance parameters (including the mean, standard deviation, 5% quantile, median, and 95% quantile) are presented in Additional file \u003cb\u003e(Supplementary Table\u0026nbsp;23\u0026ndash;28).\u003c/b\u003e\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1. Uncertainty Analysis\u003c/h2\u003e \u003cp\u003eAll estimates were provided with 95% uncertainty intervals (UI), calculated through 1,000 Monte Carlo simulations to quantify the uncertainty of the estimates[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. For the future predictions, 95% confidence intervals (CI) were used to express the precision of the data[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2. Statistical Tools\u003c/h2\u003e \u003cp\u003eIn this study, the R software package (version 4.3.3) was used for data processing, statistical analysis, and drawing the figures.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Global Trends (2021): PD Highest Worldwide; DC Concentrated in Poor Area\u003c/h2\u003e \u003cp\u003eAccording to the 2021 age-standardized data, PD have the lowest global ASIR, with 1,069.44 per 100,000 people (95% UI: 942.71\u0026ndash;1,204.58), significantly lower than CPT at 29,777.03 per 100,000 (95% UI: 26,310.27\u0026ndash;33,490.91) and CDT at 17,781.15 per 100,000 (95% UI: 13,952.40\u0026ndash;23,035.44). The highest rates of PD are observed in the Caribbean at 1,138.31 per 100,000 (95% UI: 943.48\u0026ndash;1,335.36) and Central Latin America at 1,196.97 per 100,000 (95% UI: 1,033.36\u0026ndash;1,365.93), while high-income regions like Western Europe have lower rates, at 841.70 per 100,000 (95% UI: 694.51\u0026ndash;1,008.33).\u003c/p\u003e \u003cp\u003eCPT, the most prevalent condition globally, peaks in South Asia at 31,398.81 per 100,000 (95% UI: 27,644.28\u0026ndash;35,248.05) and Tropical Latin America at 36,541.09 per 100,000 (95% UI: 31,903.79\u0026ndash;41,303.27), but remains high even in High-income North America at 30,898.22 per 100,000 (95% UI: 26,814.08\u0026ndash;34,828.49).\u003c/p\u003e \u003cp\u003eAlthough less common than CPT, CDT is more prevalent in Southeast Asia at 20,366.78 per 100,000 (95% UI: 15,172.99\u0026ndash;29,250.65) and Southern Sub-Saharan Africa at 18,238.40 per 100,000 (95% UI: 13,484.31\u0026ndash;23,381.99). In South Asia, the ASIR is 17,488.24 per 100,000 (95% UI: 13,708.08\u0026ndash;22,367.38), which is in line with the global average \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, \u003cb\u003eSupplementary Fig.\u0026nbsp;1\u0026ndash;2, Supplementary Table\u0026nbsp;1\u0026ndash;4).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Gender Differences (2021): Gender-Similar in DC; Male-Dominant PD with Aging\u003c/h2\u003e \u003cp\u003eIn females aged 2\u0026ndash;4 years, CDT has an incidence rate of 63,091 cases per 100,000 people (95% UI: 45,274\u0026ndash;81,082) and a prevalence rate of 51,043 cases per 100,000 people (95% UI: 39,599\u0026ndash;61,503). For males in the same age group, the incidence rate is 62,606 cases per 100,000 people (95% UI: 44,751\u0026ndash;80,195), and the prevalence rate is 52,060 cases per 100,000 people (95% UI: 40,473\u0026ndash;62,402). These numbers indicate that CDT rates in early childhood are comparable between sexes, with females showing marginally higher incidence and slightly lower prevalence than males (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA-B, \u003cb\u003eSupplementary Table\u0026nbsp;5\u0026ndash;6).\u003c/b\u003e\u003c/p\u003e \u003cp\u003eFor CPT, females and males exhibit comparable incidence rates in adolescence. The incidence rate in females aged 15\u0026ndash;19 is 46,126 cases per 100,000 people (95% UI: 36,363\u0026ndash;56,627), closely matching males (46,311; 36,297\u0026ndash;56,805). By age 20\u0026ndash;24, female incidence rate rises to 54,162 (95% UI: 43,928\u0026ndash;63,506), while males show a similar increase to 54,484 (44,523\u0026ndash;63,599). Both sexes demonstrate progressive risk escalation in early adulthood, with no clear evidence of earlier onset in females. (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eC-D, \u003cb\u003eSupplementary Table\u0026nbsp;7\u0026ndash;8).\u003c/b\u003e\u003c/p\u003e \u003cp\u003eIn the case of PD, females exhibit a progressive increase in prevalence rate from 4,249 cases per 100,000 people (95% UI: 2,836\u0026ndash;6,115) at ages 20\u0026ndash;24 to 13,577 cases per 100,000 (95% UI: 9,564\u0026ndash;18,310) by ages 30\u0026ndash;34. In contrast, males demonstrate consistently higher prevalence rate across all age groups, peaking at 30,512 cases per 100,000 (95% UI: 24,523\u0026ndash;36,129) in the 50\u0026ndash;54 age group. Incidence rate for males aged 50\u0026ndash;54 are 1,883 per 100,000 (95% UI: 1,225\u0026ndash;2,471). These findings indicate that males face a higher burden of PD compared to females, particularly in middle and older age groups. (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eE-F, \u003cb\u003eSupplementary Table\u0026nbsp;9\u0026ndash;10).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Age Differences (1990\u0026ndash;2021): Childhood-Adolescent DC Spike in High-Income Regions; Mid-Adulthood PD Drops in Vulnerable Populations\u003c/h2\u003e \u003cp\u003eIn the 2021 data, CDT incidence rate in the 2\u0026ndash;4 age group increased in high-income regions such as North America (High-income North America), from 50,953 cases per 100,000 people (95% UI: 26,664\u0026ndash;81,244) in 1990 to 62,195 cases per 100,000 people (95% UI: 38,499\u0026ndash;89,426) in 2021, an increase of 11,242 cases. In Australasia, the 5\u0026ndash;9 age group saw a sharp rise in incidence rate from 31,838 cases per 100,000 people (95% UI: 23,353\u0026ndash;40,203) in 1990 to 74,543 cases per 100,000 people (95% UI: 50,997\u0026ndash;101,639) in 2021, an increase of 42,705 cases. For the 10\u0026ndash;14 age group in Australasia, incidence rate increased from 98,577 cases per 100,000 people (95% UI: 85,042\u0026ndash;114,212) in 1990 to 116,847 cases per 100,000 people (95% UI: 59,428\u0026ndash;162,169) in 2021, while prevalence rate surged from 6,692 cases per 100,000 people (95% UI: 5,736\u0026ndash;7,662) to 14,081 cases per 100,000 people (95% UI: 10,649\u0026ndash;17,713) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA-B, \u003cb\u003eSupplementary Table\u0026nbsp;11\u0026ndash;12).\u003c/b\u003e\u003c/p\u003e \u003cp\u003eFor CPT, in the 15\u0026ndash;19 age group, East Asia saw a substantial increase in incidence rate, rising from 21,716 cases per 100,000 people (95% UI: 19,544\u0026ndash;23,888) in 1990 to 41,774 cases per 100,000 people (95% UI: 37,597\u0026ndash;45,952) in 2021.In the 20\u0026ndash;24 age group, Southeast Asia experienced a slight increase in incidence rate, from 55,750 cases per 100,000 people (95% UI: 44,116\u0026ndash;65,876) in 1990 to 57,159 cases per 100,000 people (95% UI: 46,406\u0026ndash;66,440) in 2021. In the 45\u0026ndash;49 age group, East Asia showed an increase in incidence rate, rising from 16,838 cases per 100,000 people (95% UI: 12,922\u0026ndash;21,749) in 1990 to 20,150 cases per 100,000 people (95% UI: 15,290\u0026ndash;26,495) in 2021. (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eC-D, \u003cb\u003eSupplementary Table\u0026nbsp;13\u0026ndash;14).\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAdditionally, the most notable changes in the incidence rate of PD were observed in the following age groups and regions. In the 25\u0026ndash;29 age group, Central Sub-Saharan Africa saw a significant decrease in incidence rate, from 2,208.82 cases per 100,000 people (95% UI: 1,152.97\u0026ndash;3,256.40) in 1990 to 935.18 cases per 100,000 people (95% UI: 417.99\u0026ndash;1,901.74) in 2021. In Oceania, the 30\u0026ndash;34 age group experienced a sharp decline, with the incidence rate falling from 1,073.71 cases per 100,000 people (95% UI: 531.81\u0026ndash;1,847.56) in 1990 to 217.43 cases per 100,000 people (95% UI: 100.78\u0026ndash;447.87) in 2021.For the 50\u0026ndash;54 age group, Oceania again showed a large reduction, with the incidence rate dropping from 2,032.57 cases per 100,000 people (95% UI: 1,169.61\u0026ndash;2,891.48) in 1990 to 526.18 cases per 100,000 people (95% UI: 212.51\u0026ndash;1,102.17) in 2021. \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eE-F, \u003cb\u003eSupplementary Table\u0026nbsp;15\u0026ndash;16).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.4. Regional Differences (1990\u0026ndash;2021): DC Rises in Affluent Regions; PD Drops in Poor Areas\u003c/h2\u003e \u003cp\u003eFrom 1990 to 2021, the ASIR of CDT in Sub-Saharan Africa decreased by 12.02% (UI: -22.38% \u0026ndash; 5.67%), while prevalence rate also declined by 6.20% (UI: -15.54% \u0026ndash; 6.63%). During the same period, Southeast Asia saw a slight increase in the ASIR of CDT by 0.57% (UI: -2.31% \u0026ndash; 3.61%) and a ASPR change of -2.70% (UI: -4.55% \u0026ndash; -0.86%). North America experienced a 10.88% rise in the ASIR of CDT (UI: -0.92% \u0026ndash; 31.61%) and a 20.08% increase in ASPR (UI: 8.43% \u0026ndash; 35.79%) from 1990 to 2021. Western Europe reported a reduction in the ASIR of CDT by 6.62% (UI: -16.65% \u0026ndash; 1.63%) and a ASPR change of -17.31% (UI: -24.20% \u0026ndash; -10.47%) during the same timeframe. (\u003cb\u003eFig.\u0026nbsp;4A-B, Supplementary Table\u0026nbsp;17\u0026ndash;18).\u003c/b\u003e\u003c/p\u003e \u003cp\u003eRegarding CPT, East Asia saw a significant increase in ASIR by 31.20% (UI: 22.31% \u0026ndash; 44.87%) from 1990 to 2021, whereas South Asia experienced a modest rise of 1.68% (UI: -0.75% \u0026ndash; 4.07%). In North America, the ASIR of CPT decreased by 2.98% (UI: -6.03% \u0026ndash; 0.18%) over the 1990\u0026ndash;2021 period, while Northern Europe had a slight increase of 0.53% (UI: -3.08% \u0026ndash; 4.70%) and Western Europe rose by 0.53% (UI: -3.08% \u0026ndash; 4.70%). In terms of ASPR, East Asia saw a decrease of 0.94% (UI: -8.73% \u0026ndash; 7.67%), South Asia decreased by -5.74% (UI: -7.48% \u0026ndash; -3.46%), North America decreased by -5.13% (UI: -8.54% \u0026ndash; -1.35%), Northern Europe rose by 2.83% (UI: -0.47% \u0026ndash; 6.60%), and Western Europe decreased by -8.91% (UI: -13.53% \u0026ndash; -4.07%) in CPT ASPR from 1990 to 2021. (\u003cb\u003eFig.\u0026nbsp;4C-D, Supplementary Table\u0026nbsp;19\u0026ndash;20).\u003c/b\u003e\u003c/p\u003e \u003cp\u003eConcerning PD, Sub-Saharan Africa experienced a significant decline in ASIR by -29.26% (UI: -40.45% \u0026ndash; -13.51%) from 1990 to 2021, with Western Sub-Saharan Africa showing an even greater decrease of -34.78% (UI: -42.87% \u0026ndash; -23.80%). In Southeast Asia, the ASIR of PD changed by -8.46% (UI: -17.34% \u0026ndash; 4.52%) during this period, while North America saw a -5.88% change (UI: -18.45% \u0026ndash; 11.71%). Western Europe reported a decrease in PD ASIR by -9.50% (UI: -27.51% \u0026ndash; 15.06%) from 1990 to 2021. (\u003cb\u003eFig.\u0026nbsp;4E-F, Supplementary Table\u0026nbsp;21\u0026ndash;22).\u003c/b\u003e\u003c/p\u003e\u003cp\u003e3.4. BAPC Prediction (2021\u0026ndash;2035): Resurgence in Childhood CDT; Improvement in Adolescent CPT ; Deterioration of PD in Middle-Aged/Elderly Populations\u003c/p\u003e \u003cp\u003eFrom 1990 to 2020, the overall ASPR of CDT gradually declined from 28,108.90 cases per 100,000 (95% UI: 28,106.42\u0026ndash;28,111.39) to 26,796.70 cases per 100,000 (95% UI: 26,794.43\u0026ndash;26,798.98), with projections indicating a rise to 29,447.78 cases per 100,000 (95% CI: 21,840.17\u0026ndash;37,055.39) by 2035. Among children under 5 years of age, prevalence rate decreased from 35,008.79 cases per 100,000 (95% UI: 35,002.69\u0026ndash;35,014.90) in 1990 to 33,917.97 cases per 100,000 (95% UI: 33,912.01\u0026ndash;33,923.93) in 2020, and is projected to increase to 43,626.47 cases per 100,000 (95% CI: 34,236.60\u0026ndash;53,016.34) by 2035.Additionally, for children aged 5\u0026ndash;9 years, prevalence rate declined from 41,641.48 cases per 100,000 (95% UI: 41,635.10\u0026ndash;41,647.86) in 1990 to 39,735.10 cases per 100,000 (95% UI: 39,729.09\u0026ndash;39,741.10) in 2020, with an anticipated rise to 43,626.47 cases per 100,000 (95% CI: 34,236.60\u0026ndash;53,016.34) by 2035. Among those aged 10\u0026ndash;14 years, prevalence rate decreased from 6,080.48 cases per 100,000 (95% UI: 6,072.15\u0026ndash;6,088.80) in 1990 to 4,910.58 cases per 100,000 (95% UI: 4,901.78\u0026ndash;4,919.38) in 2020, and is expected to reach 5,590.75 cases per 100,000 (95% CI: 4,889.02\u0026ndash;6,292.47) by 2035. (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e5\u003c/span\u003eA, \u003cb\u003eSupplementary Fig.\u0026nbsp;3,Supplementary Table\u0026nbsp;23\u0026ndash;24).\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe prevalence of CPT changed differently across age groups from 2022 to 2035. For the 5\u0026ndash;9 age group, cases fell sharply from 9,496.63 per 100,000 (95% UI: 9,489.29\u0026ndash;9,503.97) in 1990 to 8,060.55 (95% UI: 8,052.92\u0026ndash;8,068.18) in 2021, and will likely drop further to 7,163.20 (95% CI: 5,540.37\u0026ndash;8,786.02) by 2035. For the 10\u0026ndash;14 age group, cases also decreased from 26,313.72 (95% UI: 26,307.46\u0026ndash;26,319.97) to 23,989.37 per 100,000 (95% UI: 23,983.38\u0026ndash;23,995.36) between 1990 and 2021, and are expected to reach 21,217.69 (95% CI: 18,304.92\u0026ndash;24,130.45) by 2035.In the 15\u0026ndash;19 age group, cases had a small decrease from 30,747.88 (95% UI: 30,741.53\u0026ndash;30,754.23) to 30,718.23 per 100,000 (95% UI: 30,712.19\u0026ndash;30,724.27) from 1990 to 2021, but predictions show a bigger drop to 27,141.72 (95% CI: 25,177.03\u0026ndash;29,106.40) by 2035. For the 20\u0026ndash;24 age group, cases went down from 39,396.96 (95% UI: 39,390.27\u0026ndash;39,403.65) to 38,039.96 per 100,000 (95% UI: 38,033.73\u0026ndash;38,046.20) during this period, and may decrease to 35,517.78 (95% CI: 33,768.35\u0026ndash;37,267.20) by 2035. In the 25\u0026ndash;29 age group, cases slightly declined from 38,100.12 (95% UI: 38,093.23\u0026ndash;38,107.01) to 37,842.43 per 100,000 (95% UI: 37,836.17\u0026ndash;37,848.69), with a predicted fall to 35,327.53 (95% CI: 32,604.31\u0026ndash;37,050.76) by 2035.However, the 65\u0026ndash;69 age group was different. Their cases rose from 34,168.14 (95% UI: 34,157.09\u0026ndash;34,179.19) in 1990 to 32,432.73 per 100,000 (95% UI: 32,424.86\u0026ndash;32,440.59) in 2021, and are expected to keep rising to 32,336.81 (95% CI: 30,707.38\u0026ndash;33,905.99) by 2035. \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e5\u003c/span\u003eB, \u003cb\u003eSupplementary Fig.\u0026nbsp;4,Supplementary Table\u0026nbsp;25\u0026ndash;26).\u003c/b\u003e\u003c/p\u003e \u003cp\u003eFor PD, the overall ASPR decreased slightly from 28,250.67 (95% UI: 28,242.56\u0026ndash;28,258.77) in 1990 to 27,605.47 (95% UI: 27,598.21\u0026ndash;27,612.73) in 2021, with projections indicating a decrease to 28,607.75 (95% CI: 28,516.43\u0026ndash;28,699.07) by 2035.The 50\u0026ndash;54 age group exhibited a decline from 30,745.90 per 100,000 (95% UI: 30,736.34\u0026ndash;30,755.46) in 1990 to 29,595.13 (95% UI: 29,588.50\u0026ndash;29,601.75) in 2021, projected to reach 32,136.12 (95% CI: 31,336.74\u0026ndash;32,935.51) by 2035.Other age groups also demonstrated notable trends. For individuals aged 15\u0026ndash;19 years, the prevalence rate increased from 1,127.70 (95% UI: 1,114.99\u0026ndash;1,140.40) in 1990 to 1,305.39 (95% UI: 1,293.10\u0026ndash;1,317.69) in 2021, with a projected prevalence rate of 1,167.90 (95% CI: 819.15\u0026ndash;1,516.65) by 2035.Among individuals aged 20\u0026ndash;24 years, prevalence rate increased from 3,725.77 (95% UI: 3,716.24\u0026ndash;3,735.30) to 4,309.55 (95% UI: 4,300.42\u0026ndash;4,318.69), with a predicted prevalence rate of 3,992.01 (95% CI: 3,215.78\u0026ndash;4,768.25) by 2035.In the 30\u0026ndash;34 age group, prevalence rate increased from 12,864.32 (95% UI: 12,857.21\u0026ndash;12,871.43) to 13,751.46 (95% UI: 13,744.79\u0026ndash;13,758.13), with an expected increase to 14,164.95 (95% CI: 12,619.11\u0026ndash;15,710.78) by 2035.Additionally, the 65\u0026ndash;69 age group saw a slight increase from 27,409.16 (95% UI: 27,398.93\u0026ndash;27,419.39) in 1990 to 27,651.64 (95% UI: 27,644.03\u0026ndash;27,659.24) in 2021, with a projected prevalence rate of 27,142.08 (95% CI: 24,210.45\u0026ndash;30,073.71) by 2035. \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e5\u003c/span\u003eC, \u003cb\u003eSupplementary Fig.\u0026nbsp;5,Supplementary Table\u0026nbsp;27\u0026ndash;28).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e4.1. Comprehensive Comparison of Temporal Trends and Future Predictions\u003c/h2\u003e \u003cp\u003eThe temporal trends of CDT, CPT, and PD exhibit distinct epidemiological patterns. Between 1990 and 2021, the global ASPR of CDT declined from 28,108.90 to 26,796.70 cases per 100,000 people. However, the BAPC model projects a resurgence to 29,447.78 cases per 100,000 by 2035. This suggests that despite short-term public health successes, persistent inequalities in oral hygiene infrastructure\u0026mdash;particularly in low-income regions\u0026mdash;may drive a future rebound of CDT [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. For CPT, while the global prevalence has decreased over the past three decades, its ASIR among adolescents and young adults (15\u0026ndash;24 years) has risen sharply in specific regions. In East Asia, the incidence rate of CPT in the 15\u0026ndash;19 age group surged between 1990 and 2021. Although economic development and dietary shifts may contribute to a projected slight decline in global CPT prevalence by 2035, the persistent rise in adolescent cases underscores the urgent need for targeted interventions in high-risk regions[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Meanwhile, PD demonstrates a divergent trajectory. Despite a modest decline in overall prevalence from 1990 to 2021, projections indicate a potential deterioration by 2035. This trend is particularly pronounced among middle-aged and elderly populations (e.g., in Oceania, the 50\u0026ndash;54 age group saw incidence rate drop by 74% from 1990 to 2021, yet global prevalence remains high due to aging demographics). These patterns highlight the lifespan-specific nature of oral diseases: CDT and CPT predominantly affect children and adolescents, whereas PD disproportionately burdens older adults, necessitating age-tiered prevention\u0026mdash;fluoride varnish programs in preschools and geriatric PD screening by non-dental health professionals in primary care systems [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e4.2. Comparison of Gender Differences and Public Health Implications\u003c/h2\u003e \u003cp\u003eGender differences in oral health reveal nuanced disparities with public health implications. For CDT in early childhood, females show a marginally higher ASIR of 63,091 per 100,000 compared to males at 62,606 per 100,000 but slightly lower prevalence than males. This indicates comparable early-life exposure between sexes rather than a clear female disadvantage [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Regarding CPT, both sexes exhibit nearly identical incidence rates in adolescence, with females and males showing similar rates in the 15\u0026ndash;19 and 20\u0026ndash;24 age groups. This finding contrasts with some regional studies, which show more pronounced gender differences[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. The reason for this discrepancy may be that, in these age groups, the global perspective of GBD studies, which involves a vast amount of data, masks inherent gender differences in risk, leading to similar rates of incidence across genders. Conversely, PD demonstrates a pronounced male-dominant burden with aging. While females show a progressive increase in prevalence rate from the 20\u0026ndash;24 age group to the 30\u0026ndash;34 age group, males exhibit substantially higher rates across all ages, peaking in the 50\u0026ndash;54 age group. Male incidence rate in this group highlights an age-dependent escalation of risk. This aligns with projections that PD prevalence in males aged 50\u0026ndash;54 will rise by 2035, emphasizing a critical need for targeted interventions [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. These findings focus on two policy directions: early-life CDT prevention programs that require sex-neutral approaches and age-specific PD management for males, especially those over 50 years. The predicted rise of childhood CDT in high-income regions and ongoing PD burden in older males need strategies that combine screening, education, and socioeconomic interventions to address disparities, particularly through gender-neutral school fluoride initiatives and task-shifting PD care to nurses in low-resource settings [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e4.3. In-Depth Comparison of Age Differences\u003c/h2\u003e \u003cp\u003eSustained public health efforts have led to a gradual decline in the prevalence of CDT among children under 5 years old, with a notable reduction observed from 1990 to 2020. However, projections indicate a concerning reversal, with the prevalence expected to surge by 2035. This resurgence is particularly pronounced in high-income regions, such as North America and Australasia. Among children aged 2\u0026ndash;4, the incidence rate increased significantly from 1990 to 2021, and a similar trend was observed in the 5\u0026ndash;9 age group. These trends highlight the growing need for targeted interventions to address emerging risk factors in affluent populations[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile CPT remains more prevalent than CDT globally, its overall prevalence has slightly decreased from 1990 to 2021, with projections indicating this decline will continue through 2035. However, a concerning trend emerges in East Asia, where the incidence of CPT among adolescents aged 15\u0026ndash;19 more than doubled during the same period. This stark divergence highlights a dual burden: declining rates in high-income regions, contrasted with persistently high rates in low-income areas. These differences may be driven by dietary shifts and limited access to preventive care in the latter regions, calling for subsidized fluoride toothpaste distribution in East Asian schools and AI-powered teledentistry for elderly PD patients in Sub-Saharan Africa [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePD, which demonstrated the highest global incidence among the three conditions in 2021, presents a paradoxical trend. While its overall prevalence has decreased slightly, projections suggest a resurgence by 2035. The middle-aged and elderly populations face disproportionate risks, with males aged 50\u0026ndash;54 experiencing the highest prevalence. Past research has indicated that periodontitis was highly prevalent in regions like Central Sub - Saharan Africa and Oceania[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. However, alarmingly, these regions have recently reported dramatic declines in PD incidence, which might be attributed to underreporting rather than genuine progress, given persistent healthcare disparities.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e4.4. Integrated Comparison of Regional Differences in Oral Health\u003c/h2\u003e \u003cp\u003eRegional disparities in oral disease prevalence and incidence are shaped by complex interactions between socioeconomic factors, healthcare infrastructure, and cultural practices. Data from 1990 to 2021 confirm that low-income regions, such as Sub-Saharan Africa and Southeast Asia, continue to face high burdens of CDT, driven by limited access to oral healthcare and nutritional challenges[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. For instance, Sub-Saharan Africa experienced a 12.02% reduction in CDT incidence rate and a 6.20% decline in prevalence rate, while Southeast Asia saw a marginal 0.57% increase in CDT incidence rate alongside a 2.70% decrease in prevalence rate. These trends highlight persistent inequities in preventive care despite localized improvements[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn contrast, middle-income regions like East Asia reported a 31.20% surge in CPT incidence rate, likely tied to rapid dietary shifts and delayed public health responses. High-income regions, however, demonstrated divergent trajectories: North America saw a 10.88% rise in CDT incidence rate and 20.08% increase in prevalence rate, whereas Western Europe reduced CDT incidence rate by 6.62% and prevalence by 17.31%. Concurrently, CPT rates in North America and Northern Europe remained stable or declined modestly, underscoring the effectiveness of sustained preventive policies[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePD exhibited the most striking regional contrasts. Sub-Saharan Africa achieved significant progress, with PD incidence rate declining by 29.26% and Western Sub-Saharan Africa by 34.78%, likely due to targeted hygiene interventions. Conversely, high-income regions like North America and Western Europe reported minimal reductions in PD incidence rate. This stagnation aligns with projections of worsening PD burdens among aging populations, suggesting that lifestyle factors and sequelae of restorative treatments may offset gains from advanced healthcare systems, demanding policy integration of oral health into Sustainable Development Goals 3[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe current research has several methodological constraints that should be acknowledged. First, our analysis depended entirely on pre-existing datasets rather than original data collection[\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. This approach introduces potential inaccuracies because different geographic areas use inconsistent measurement standards and reporting formats. Second, while statistical modeling provided a useful framework for examining disease patterns, these computational tools have inherent simplifications. The models likely omitted important social and biological variables that jointly influence disease outcomes. Third, our descriptions of temporal trends primarily relied on point estimates of incidence changes without accounting for overlapping UIs between periods. This approach prioritizes clarity in reporting but may obscure potential uncertainties in interpreting true increases or declines[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Incorporating these factors in future studies could substantially improve the interpretation of epidemiological trends.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eIn line with our aim to guide targeted oral health policy, GBD 2021 data highlight notable trends of DC and PD from 1990 to 2021. CDT declined in some high-income regions yet is projected to resurge by 2035, while CPT remains widespread in older populations, particularly in East Asia. PD persists among middle-aged and elderly males, with Sub-Saharan Africa facing substantial burdens. Low-income regions continue to shoulder disproportionate oral health inequalities. These findings underscore the need for age- and region-specific interventions to mitigate long-term effects and strengthen global oral health equity.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e6.1. Ethics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eOur study utilized publicly accessible GBD data, thus eliminating the need for informed consent or ethical review. Since it exclusively used publicly accessible data that did not contain any confidential or personally identifiable patient information. Given the nature of the data, informed consent was not required, and no ethical review or patient consent was needed, ensuring both transparency and ethical integrity in using secondary, non-identifiable health data for our research.\u003c/p\u003e\n\u003cp\u003e6.2. Consent for publication\u003c/p\u003e\n\u003cp\u003eThe authors agree to publish.\u003c/p\u003e\n\u003cp\u003e6.3. Competing interests\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e6.4. Acknowledgments\u003c/p\u003e\n\u003cp\u003eWe sincerely thank the Institute for Health Metrics and Evaluation at the University of Washington, the GBD collaborators, and all staff who provided data for this study. We also extend our gratitude to the GBDR research team for providing JD_GBDR (V2.36, Jingding Medical Technology Co., Ltd.). The views expressed in this paper are solely those of the authors and do not represent the official positions of their affiliated organizations.\u003c/p\u003e\n\u003cp\u003e6.5. Patient and public involvement\u003c/p\u003e\n\u003cp\u003ePatients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.\u003c/p\u003e\n\u003cp\u003e6.6. Authors\u0026rsquo; contributions\u003c/p\u003e\n\u003cp\u003eJiangqiuchen Wu: Formal analysis, Data curation, Writing draft.\u003c/p\u003e\n\u003cp\u003eJiangqiuchen Wu ,Jinhao Chen : Writing-Original draft preparation, Results interpretation.\u003c/p\u003e\n\u003cp\u003eJiangqiuchen Wu ,Leilei Zhou: Data inspection and modification, Writing Revision\u003c/p\u003e\n\u003cp\u003eLeilei Zhou ,Cunming Lv: Supervision, Reviewing and Editing\u003c/p\u003e\n\u003cp\u003e6.7. Funding\u003c/p\u003e\n\u003cp\u003eThe authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e6.8. Availability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analyzed during the current study are available from the Global Health Data Exchange query tool (http://ghdx.healthdata.org/gbd-results-tool).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJain N, Dutt U, Radenkov I, Jain S. WHO\u0026rsquo;s global oral health status report 2022: Actions, discussion and implementation. Oral Dis. 2024;30:73\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeres M, Macpherson L, Weyant R, Daly B, Venturelli R, Mathur M, et al. Oral diseases: a global public health challenge. Lancet. 2019;394:249\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKocher T, Meisel P, Baumeister S, Holtfreter B. Impact of public health and patient-centered prevention strategies on periodontitis and caries as causes of tooth loss in high-income countries. 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J Natl Cancer Inst. 1959;22 4:719\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Global burden, Dental caries, Periodontal disease, Oral health disparities, Public health interventions","lastPublishedDoi":"10.21203/rs.3.rs-5609270/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5609270/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe global burden of dental caries (DC) and periodontal disease (PD) has evolved significantly from 1990 to 2021, influenced by demographic shifts and socioeconomic factors in oral health interventions. This study aims to analyze historical trends, project future trajectories to 2035, and identify inequalities to inform equitable oral health policy development.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eUtilizing data from the 2021 Global Burden of Disease Study (GBD), we analyzed incidence ,prevalence, age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) of caries of deciduous teeth (CDT), caries of permanent teeth (CPT) and PD from 1990 to 2021. Bayesian age-period-cohort (BAPC) models with Integrated Nested Laplace Approximation (INLA) were employed to forecast trends through 2035, integrating second-order smoothing effects, overdispersion adjustments, and uncertainty quantification via 1,000 Monte Carlo simulations (95% UI) with future precision expressed as 95% confidence intervals (CI).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFrom 1990 to 2021, CDT prevalence declined regionally, while PD remained prevalent, particularly among middle-aged and elderly populations in high-burden regions like Sub-Saharan Africa and Southeast Asia. Significant gender disparities were noted, with females experiencing comparable deciduous DC in early childhood, whereas males showed dominant PD rates in middle/older ages. Low-income regions still face high burdens despite progress. Projections to 2035 suggest a CDT resurgence and aging-driven PD persistence.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eDC and PD persist as major public health issues, shaped by gender, age, and regional disparities. The projected resurgence of childhood DC and persistent PD prevalence by 2035 underscore the need for targeted interventions. Tailored public health initiatives are essential to mitigate long-term impacts and improve global oral health outcomes.\u003c/p\u003e","manuscriptTitle":"Global, Regional, and National Levels and Trends in Burden of Dental Caries and Periodontal Disease from 1990 to 2035：Result From the Global Burden of Disease Study 2021","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-02 19:01:36","doi":"10.21203/rs.3.rs-5609270/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-09T06:57:05+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-08T19:43:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"206220048810228929228884864049584414115","date":"2025-04-08T18:00:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-03T06:57:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"263547617616390666390274582976675070441","date":"2025-04-03T06:54:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"122322815690123708885380446250855564837","date":"2025-04-01T15:42:34+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-01T14:58:26+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-01T11:55:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2025-03-29T05:13:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c94b65e4-aa17-406a-97f7-8e8f6365b88f","owner":[],"postedDate":"April 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-06-02T16:00:11+00:00","versionOfRecord":{"articleIdentity":"rs-5609270","link":"https://doi.org/10.1186/s12903-025-06108-w","journal":{"identity":"bmc-oral-health","isVorOnly":false,"title":"BMC Oral Health"},"publishedOn":"2025-05-29 15:57:14","publishedOnDateReadable":"May 29th, 2025"},"versionCreatedAt":"2025-04-02 19:01:36","video":"","vorDoi":"10.1186/s12903-025-06108-w","vorDoiUrl":"https://doi.org/10.1186/s12903-025-06108-w","workflowStages":[]},"version":"v1","identity":"rs-5609270","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5609270","identity":"rs-5609270","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}