Regional Disparities in the Prevalence and Severity of Early Childhood Caries Among Preschoolers Living in Poverty in Costa Rica

Authors

  • Adrián Gómez-Fernández Master's Program in Pediatric Dentistry, Faculty of Dentistry, Postgraduate Studies System, University of Costa Rica, San José, Costa Rica. Author https://orcid.org/0000-0003-2132-0137
  • Katherine Molina-Chaves Master's Program in Pediatric Dentistry, Faculty of Dentistry, Postgraduate Studies System, University of Costa Rica, San José, Costa Rica. Author https://orcid.org/0000-0001-7715-4778
  • Sylvia Gudiño-Fernández Master's Program in Pediatric Dentistry, Faculty of Dentistry, Postgraduate Studies System, University of Costa Rica, San José, Costa Rica. Author https://orcid.org/0000-0002-8746-1066

DOI:

https://doi.org/10.15517/at7ad013

Keywords:

Dental caries; Oral health; Preschool children; Health inequities; Regional disparities; Costa Rica; Poverty.

Abstract

Early childhood dental caries remains a major public health concern, especially among populations affected by socioeconomic and geographic disparities. In Costa Rica, persistent regional inequalities may influence the burden and severity of this condition. To analyze regional disparities in the prevalence and severity of dental caries among Costa Rican preschool children living in poverty. A secondary analysis was conducted using data from a descriptive, cross-sectional study carried out in 2013. The national sample included 803 children under 81 months of age enrolled in government-run centers for early childhood care and nutrition (CEN-CINAI). Clinical assessments were performed using the ICDAS system. Descriptive statistics and regional comparison tests were applied. The national caries prevalence in Costa Rica was 84.81%. Significant regional differences in severity were observed, with higher averages of affected teeth and surfaces in the Chorotega and Brunca regions. While incipient lesions (ICDAS 1-2) were most frequent, a substantial burden of moderate and severe lesions (ICDAS 3-6) was also detected, particularly in rural areas with greater structural vulnerability and limited access to oral health services.The high prevalence of dental caries and the documented regional inequalities highlight the need to strengthen prevention, early diagnosis, and timely treatment. Integrating a territorial approach into oral health policy-through early detection, preventive interventions, caregiver education, and mobile dental services-may help reduce disparities and improve pediatric oral health outcomes.

References

Watt R.G., Daly B., Allison P., et al. Ending the neglect of global oral health: time for radical action. Lancet. 2019; 394 (10194): 261-272. doi:10.1016/S0140-6736(19)31133-X

Wen P.Y.F., Chen M.X., Zhong Y.J., Dong Q.Q., Wong H.M. Global burden and inequality of dental caries, 1990 to 2019. J Dent Res. 2022; 101 (4): 392-399. doi:10.1177/00220345211056247

Petersen P.E. Challenges to improvement of oral health in the 21st century--the approach of the WHO Global Oral Health Programme. Int Dent J. 2004; 54 (6 Suppl 1): 329-343. doi:10.1111/j.1875-595x.2004.tb00009.x

López Torres A.C., Bermúdez Mora G.A. Salud bucal costarricense: análisis de la situación de los últimos años. Odontol Sanmarquina. 2020; 23 (3): 341-349. doi:10.15381/os.v23i3.18403

Prasad M., Manjunath C., Murthy A.K., Sampath A., Jaiswal S., Mohapatra A. Integration of oral health into primary health care: a systematic review. J Family Med Prim Care. 2019; 8 (6): 1838-1845. doi:10.4103/jfmpc.jfmpc_286_19

Watt R.G., Listl S., Peres M., Heilmann A. Social inequalities in oral health: from evidence to action. London: International Centre for Oral Health Inequalities Research & Policy; 2015 [Internet]. Available from: https://media.news.health.ufl.edu/misc/cod-oralhealth/docs/posts_frontpage/SocialInequalities.pdf

Peres M.A., Macpherson L.M.D., Weyant R.J., et al. Oral diseases: a global public health challenge [published correction appears in Lancet. 2019 Sep 21; 394 (10203): 1010. doi: 10.1016/S0140-6736(19)32079-3.]. Lancet. 2019;394(10194):249-260.doi:10.1016/S0140-6736(19)31146-8

Petersen P.E., Bourgeois D., Ogawa H., Estupinan-Day S., Ndiaye C. The global burden of oral diseases and risks to oral health. Bull World Health Organ. 2005; 83 (9): 661-669.

Frencken J.E., Sharma P., Stenhouse L., Green D., Laverty D., Dietrich T. Global epidemiology of dental caries and severe periodontitis - a comprehensive review. J Clin Periodontol. 2017; 44 Suppl 18: S94-S105. doi:10.1111/jcpe.12677

Feldens C.A., Alvarez L., Acevedo A.M., et al. Early-life sugar consumption and breastfeeding practices: a multicenter initiative in Latin America. Braz Oral Res. 2023; 37: e104. doi:10.1590/1807-3107bor-2023.vol37.0104

Programa Estado de la Nación. Informe Estado de la Nación 2024: Capítulo 2- Bienestar social y equidad. San José (CR): Consejo Nacional de Rectores; 2024. p. 76-103. Available from: https://repositorio.conare.ac.cr/server/api/core/bitstreams/92ab73f3-1cfe-4327-9717-060d2db111af/content

Instituto Nacional de Estadística y Censos (INEC). Encuesta Nacional de Hogares: informe de resultados. San José: INEC; 2024. Available from: https://admin.inec.cr/sites/default/files/2024-10/reenaho2024.pdf.pdf

Marmot M., Friel S., Bell R., Houweling T.A., Taylor S.; Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008; 372 (9650): 1661-1669. doi:10.1016/S0140-6736(08)61690-6

Lorenzo S., Apelo F., Olmos P., Massa F., Laporta P., Zubiaguirre T. Salud bucal como derecho ciudadano y su relación con la prevención de enfermedades no transmisibles. Univ Diálogo. 2022; 12 (2): 101-116. doi:10.15359/udre.12-2.5

Pacheco Jiménez J.F. Desigualdades territoriales en el acceso a los servicios de salud pública (CCSS). Informe Estado de la Nación en Desarrollo Humano Sostenible 2024. San José (CR): Programa Estado de la Nación; 2024. Available from: https://repositorio.conare.ac.cr/server/api/core/bitstreams/0c7aaebe-4377-4cd4-8a80-150c1065c0c4/content

Paiva S.M., Martins L.P., Bittencourt J.M., et al. Impact on oral health-related quality of life in infants: multicenter study in Latin American countries. Braz Dent J. 2022; 33 (2): 61-67. doi:10.1590/0103-6440202204929

Ministerio de Salud de Costa Rica. Manual operativo de los CEN-CINAI. San José: Ministerio de Salud; 2020. Available from: https://www.cen-cinai.go.cr/wp-content/uploads/2022/05/Manual_Operativo_jornadas_Vespertina_y_Nocturna.pdf

Kassebaum N.J., Smith A.G.C., Bernabé E., et al. Global, regional, and national prevalence, incidence, and disability-adjusted life years for oral conditions for 195 countries, 1990-2015: a systematic analysis for the global burden of diseases, injuries, and risk factors. J Dent Res. 2017; 96 (4): 380-387. doi:10.1177/0022034517693566

Gudiño-Fernández S. Lactancia materna, biberón, azúcares en solución y caries de la temprana infancia en el San José urbano. Odovtos - Int J Dent Sc. 2007; 9: 77-88. https://www.redalyc.org/pdf/4995/499551912016.pdf

Gudiño-Fernández S. Higiene oral, entorno familiar, azúcares sólidos, enfermedades respiratorias y caries de la temprana infancia en el área metropolitana de San José-Costa Rica. Odovtos - Int J Dent Sc. 2007; 9: 97-104. https://www.redalyc.org/pdf/4995/499551912018.pdf

Goldstein R., Gudiño-Fernández S. Riesgos nutricionales e higiénicos asociados a la caries de la temprana infancia en el binomio madre-hijo en el distrito Josefino de Río Azul. Rev Cient Odontol. 2007; 3 (2): 74-80. Available from: http://www.redalyc.org/articulo.oa?id=324227907007

Gudiño-Fernández S. Prevalencia y análisis descriptivo del patrón de caries dental en niños costarricenses de 12 a 24 meses. Odovtos - Int J Dent Sc. 2003; 5: 68-75.

Dikmen B. ICDAS II criteria (international caries detection and assessment system). J Istanb Univ Fac Dent. 2015; 49 (3): 63-72. doi:10.17096/jiufd.38691

Ministerio de Planificación Nacional y Política Económica (MIDEPLAN). Mapa de regiones de Costa Rica. San José (CR): MIDEPLAN; 2023. Available from: https://documentos.mideplan.go.cr/share/s/zCZzjyCaTOSLZWX74BMTOQ

Sheiham A., Watt R.G. The common risk factor approach: a rational basis for promoting oral health. Community Dent Oral Epidemiol. 2000; 28 (6): 399-406. doi:10.1034/j.1600-0528.2000.028006399.x

Ismail A.I., Sohn W., Tellez M., et al. The International Caries Detection and Assessment System (ICDAS): an integrated system for measuring dental caries. Community Dent Oral Epidemiol. 2007; 35 (3): 170-178. doi:10.1111/j.1600-0528.2007.00347.x

Moynihan P.J., Kelly S.A. Effect on caries of restricting sugars intake: systematic review to inform WHO guidelines. J Dent Res. 2014; 93 (1): 8-18. doi:10.1177/0022034513508954

Nath S., Sethi S., Bastos J.L., et al. A global perspective of racial-ethnic inequities in dental caries: protocol of systematic review. Int J Environ Res Public Health. 2022; 19 (3): 1390. doi:10.3390/ijerph19031390

Tinanoff N., Baez R.J., Diaz Guillory C., et al. Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: global perspective. Int J Paediatr Dent. 2019; 29 (3): 238-248. doi:10.1111/ipd.12484

Fejerskov O., Nyvad B., Kidd E.A.M. Dental caries: the disease and its clinical management. 3rd ed. Oxford: Wiley Blackwell; 2015. p. 115-160.

Casamassimo P.S., Thikkurissy S., Edelstein B.L., Maiorini E. Beyond the dmft: the human and economic cost of early childhood caries. J Am Dent Assoc. 2009; 140 (6): 650-657. doi:10.14219/jada.archive.2009.0250

Peña-Alegre M., Porcel I.N., Mattos-Vela M.A., Villavicencio-Caparó E. Impact of oral conditions on quality of life in Peruvian preschoolers in rural and urban areas. Odovtos - Int J Dent Sc. 2023; 25 (3): 162-173. doi:10.15517/ijds.2023.55835

Gudiño-Fernández S., Gómez-Fernández A., Molina-Chaves K., Barahona-Cubillo J., Fantin R., Barboza-Solís C. Prevalence of dental caries among Costa Rican male students aged 12-22 years using ICDAS-II. Odovtos - Int J Dent Sc. 2021; 23 (2):181-195. doi: 10.15517/IJDS.2021.45650

Ortiz Magdaleno M. Salud bucal en América Latina: desafíos por afrontar. Rev Latinoam Difus Cient. 2024; 6 (11): 142-156.

Ramírez K., Gómez-Fernández A. Dental caries in 12-year-old schoolchildren who participate in a preventive and restorative dentistry program Odovtos - Int J Dent Sc. 2022; 24 (2): 136-144. doi:10.15517/IJDS.2021.47337

Maceira D., Brumana L., Aleman J.G. Reducing the equity gap in child health care and health system reforms in Latin America. Int J Equity Health. 2022; 21 (1): 29. doi:10.1186/s12939-021-01617-w

Pucca G.A. Jr., Gabriel M., de Araujo M.E., de Almeida F.C. Ten years of a national oral health policy in Brazil: innovation, boldness, and numerous challenges. J Dent Res. 2015; 94 (10): 1333-1337. doi:10.1177/0022034515599979

de Sousa F.S.O., Dos Santos A.P.P., Nadanovsky P., Hujoel P., Cunha-Cruz J., de Oliveira B.H. Fluoride varnish and dental caries in preschoolers: a systematic review and meta-analysis. Caries Res. 2019; 53 (5): 502-513. doi:10.1159/000499639

Kshirsagar M., Dodamani A., Pimpale S., et al. Mobile dental clinics: bringing smiles on wheels. Cureus. 2025;17 (5): e83873. doi:10.7759/cureus.83873

Galante M.L., Otálvaro-Castro G.J., Cornejo-Ovalle M.A., Patiño-Lugo D.F., Pischel N., Giraldes A.I., Carrer F.C. de A. Oral health policy in Latin America: challenges for better implementation. EJDENT [Internet]. 2022 Mar. 30; 3 (2): 10-6. Available from: https://ejdent.org/index.php/ejdent/article/view/167

Published

2025-09-05